Active NPI
Nicholas John Anderjack, PA-C
- Physician Assistant
- Rochester, NY
National Provider Identifier
1861152589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 027653-01
- Practice address
- 1160 Chili Ave
Rochester, NY 14624-3035 - Phone
- (585) 426-4990
- NPI assigned
- Dec 21, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA062858 | PA | |
| Physician Assistant | 363A00000X | OA005933 | PA | |
| Physician Assistant | 363A00000X | 027653-01 | NY | Primary |
Addresses
Primary practice location
1160 Chili Ave
Rochester, NY 14624-3035
Mailing address
1107 Greenlawn Dr
Pittsburgh, PA 15220-3103
Phone (412) 443-7405
Other practice location 1
191 N Main St
Wellsville, NY 14895-1150
Phone (585) 593-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220324002341 | NY | Practitioner - Physician Assistant | 3375938525 | Reassigns benefits to 2 organizations |
| I20240227003491 | NV | Practitioner - Physician Assistant | 3375938525 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1400 Medical Pkwy
Carson City, NV 89703-4624
Phone (775) 883-1700
1600 Medical Pkwy
Carson City, NV 89703-4625
Phone (775) 220-9149
Hospital & facility affiliations
- Carson Tahoe Regional Medical Center
- Carson Valley Health
- Barton Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027653-01 | NY | MD | Physician Assistant |
| MA062858 | PA | MD | Physician Assistant |
| OA005933 | PA | MD | Physician Assistant |
Organizations & group practices 3
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.
-
- Hospitalist Physician
- Carson City, NV
- NPI 1063608701
NV
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Carson City, NV
- NPI 1255360160
Hospital
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Carson City, NV
- NPI 1568281988
Hospital
-
- Community/Behavioral Health Agency
- Gardnerville, NV
- NPI 1104482918
Hospital
-
- Critical Access Hospital
- Gardnerville, NV
- NPI 1396799102
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640044800000",
"number": "1861152589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 GREENLAWN DR",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152203103",
"telephone_number": "412-443-7405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 CHILI AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146243035",
"telephone_number": "585-426-4990"
}
],
"practiceLocations": [
{
"address_1": "191 N Main St",
"address_purpose": "LOCATION",
"city": "Wellsville",
"state": "NY",
"postal_code": "148951150",
"country_code": "US",
"telephone_number": "585-593-1100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERJACK",
"first_name": "NICHOLAS",
"middle_name": "JOHN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-21",
"last_updated": "2021-12-21",
"certification_date": "2021-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA062858",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "OA005933",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "027653-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.