Individual provider Active NPI

Marley Jane Wahl

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1861910697
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
021251 Issued in NY
Practice address
1425 Portland Ave
Rochester, NY 14621-3001
Phone
(585) 922-9080
NPI assigned
Aug 31, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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 021251 NY Primary

Addresses

Primary practice location

1425 Portland Ave
Rochester, NY 14621-3001

Mailing address

689 Gillett Rd
Rochester, NY 14624-1036
Phone (607) 972-8591

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171017002087 NY Practitioner - Physician Assistant 9436425527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians

Practice addresses (Care Compare)

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-4000

1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
021251NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital CurrentSince Oct 16, 2017 Accepting new patients
Rochester General Hospital CurrentSince Oct 16, 2017 Accepting new patients

Locations

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

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.

NPI Registry JSON

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

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1861910697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "689 GILLETT RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146241036",
            "telephone_number": "607-972-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "MARLEY",
        "middle_name": "JANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-31",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.