Active NPI
Graham R Widrick, PT
- Physical Therapist
- Fairport, NY
National Provider Identifier
1821079427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 62 028214
- Practice address
- 44 Gentian Way
Fairport, NY 14450-9212 - Phone
- (585) 880-9553
- NPI assigned
- Nov 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 62 028214 | NY | Primary |
Addresses
Primary practice location
44 Gentian Way
Fairport, NY 14450-9212
Mailing address
44 Gentian Way
Fairport, NY 14450-9212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C775Q | Other | NC | BCBS |
| 5142742 | Other | NC | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62 028214 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Raleigh Neurosurgical Clinic, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Neurological Surgery Physician
- Raleigh, NC
- NPI 1598702490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253145600000",
"number": "1821079427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 GENTIAN WAY",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144509212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 GENTIAN WAY",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144509212",
"telephone_number": "585-880-9553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDRICK",
"first_name": "GRAHAM",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2009-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "62 028214",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "C775Q",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5142742",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.