NPIMap

Individual provider Active NPI

Alyssa Weaver, PA-C

  • Physician Assistant
  • North Tonawanda, NY
National Provider Identifier
1841911039
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
43 Niagara St
North Tonawanda, NY 14120-6115
Phone
(716) 690-2001
Fax
(716) 690-2239
NPI assigned
Sep 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

43 Niagara St
North Tonawanda, NY 14120-6115

Mailing address

43 Niagara St
North Tonawanda, NY 14120-6115
Phone (585) 297-9962

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alyssaweaver@canalsideprimary.medentdirect.com Direct

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
I20221111000601 NY Practitioner - Physician Assistant 2062889660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canalside Primary Care PCGroup PAC ID 0840381984, 3 clinicians

Practice addresses (Care Compare)

43 Niagara St
N Tonawanda, NY 14120-6115
Phone (716) 690-2001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleida Health PastSince Sep 11, 2022 Accepting new patients

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.

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": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1841911039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 NIAGARA ST",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141206115",
            "telephone_number": "585-297-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 NIAGARA ST",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141206115",
            "telephone_number": "716-690-2001",
            "fax_number": "716-690-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "ALYSSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alyssaweaver@canalsideprimary.medentdirect.com",
            "affiliation": "N",
            "endpointDescription": "Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "43 Niagara St",
            "city": "North Tonawanda",
            "state": "NY",
            "country_code": "US",
            "postal_code": "141206115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Tonawanda, NY

Sources for this page

Verify at the official NPI Registry.