Individual provider Active NPI

Herman S. Mogavero, M.D.

  • Dermatology Physician
  • Buffalo, NY
National Provider Identifier
1841257078
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
131152-1 Issued in NY
Practice address
85 High St
Buffalo, NY 14203-1149
Phone
(716) 857-8615
Fax
(716) 250-5942
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 131152-1 NY Primary

Addresses

Primary practice location

85 High St
Buffalo, NY 14203-1149

Mailing address

425 Essjay Rd Ste 170
Williamsville, NY 14221-5782
Phone (716) 630-1219

Other identifiers 9

IdentifierTypeStateIssuer
161000580OtherNYEMPIRE
000508601001OtherNYHELATH NOW
00010120501OtherNYUNIVERA
0021748OtherNYGHI
0300549OtherNYIHA
070003237OtherNYRR MEDICARE
131152-1WOtherNYWORKERS COMPENSATION
00721962MedicaidNY
161000580OtherNYNORTH AMERICAN PREFERRED

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address production@direct.buffalomedicalgroup.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000817 NY Practitioner - Dermatology 0244291243 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
131152-1NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Buffalo Medical Group, P.C. CurrentSince Jan 1, 1970 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Jan 1, 1970 Accepting new patients

Locations

100 High St
#13282
Buffalo, NY 14203

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

6333 Main St
Williamsville, NY 14221
Phone (716) 632-3545

325 Essjay Rd
Ste 110
Williamsville, NY 14221
Phone (716) 630-1047

425 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 630-1219

Interoperability endpoints

  • Direct secure messaging: production@direct.buffalomedicalgroup.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1841257078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ESSJAY RD STE 170",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215782",
            "telephone_number": "716-630-1219",
            "fax_number": "716-817-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 HIGH ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031149",
            "telephone_number": "716-857-8615",
            "fax_number": "716-250-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGAVERO",
        "first_name": "HERMAN",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "131152-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE",
            "identifier": "161000580",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HELATH NOW",
            "identifier": "000508601001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010120501",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0021748",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "0300549",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "070003237",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "131152-1W",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00721962",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH AMERICAN PREFERRED",
            "identifier": "161000580",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "production@direct.buffalomedicalgroup.com",
            "affiliation": "N",
            "address_1": "85 High St",
            "city": "Buffalo",
            "state": "NY",
            "country_code": "US",
            "postal_code": "142031149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.