NPIMap

Individual provider Active NPI

Tammy Bernadette Ervolina-Kroll, RPA-C

  • Physician Assistant
  • Williamsville, NY
National Provider Identifier
1801852777
Registry record updated Dec 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1540 Maple Rd
Williamsville, NY 14221-3647
Phone
(716) 580-1813
Fax
(716) 564-1134
NPI assigned
Apr 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Surgical Physician Assistant 363AS0400X 006387-1 NY

Addresses

Primary practice location

1540 Maple Rd
Williamsville, NY 14221-3647

Mailing address

2273 W River Rd
Grand Island, NY 14072-2056
Phone (716) 774-1356

Other identifiers 1

IdentifierTypeStateIssuer
02073210MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080103000189 NY Practitioner - Physician Assistant 9638259625 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delphi Healthcare PLLCGroup PAC ID 9537229661, 68 clinicians

Practice addresses (Care Compare)

845 Routes 5 and 20
Irving, NY 14081-9706
Phone (716) 951-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as group
Quality
76.13
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
006387-1NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Ub Family Medicine, Inc Current Accepting new patients
Buffalo Thoracic Surgical Associates PC Past Accepting new patients

Locations

100 High St
#13282
Buffalo, NY 14203

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

100 High St
#C3
Buffalo, NY 14203
Phone (716) 859-2243

100 High St
#C365
Buffalo, NY 14203
Phone (716) 859-3392

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324598400000",
    "number": "1801852777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2273 W RIVER RD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140722056",
            "telephone_number": "716-774-1356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647",
            "telephone_number": "716-580-1813",
            "fax_number": "716-564-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERVOLINA-KROLL",
        "first_name": "TAMMY",
        "middle_name": "BERNADETTE",
        "name_prefix": "Mrs.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2011-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "006387-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073210",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.