Individual provider Active NPI

Andrea R Miller, PA

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1902265085
Registry record updated Jan 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
019523 Issued in NY
Practice address
77 Goodell St Ste 340
Buffalo, NY 14203-1243
Phone
(716) 645-9715
NPI assigned
Feb 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2020

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 019523 NY Primary

Addresses

Primary practice location

77 Goodell St Ste 340
Buffalo, NY 14203-1243

Mailing address

308 Hopkins Rd
Williamsville, NY 14221-3434
Phone (716) 946-5652

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
I20160516001290 NY Practitioner - Physician Assistant 0446549398 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019523NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ub Family Medicine, Inc Current Accepting new patients

Locations

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

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": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579305600000",
    "number": "1902265085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 HOPKINS RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213434",
            "telephone_number": "716-946-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 GOODELL ST STE 340",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031243",
            "telephone_number": "716-645-9715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "ANDREA",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-17",
        "last_updated": "2020-01-18",
        "certification_date": "2020-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.