NPIMap

Organization Active NPI

Chautauqua Medical Practice, P.C.

  • Family Medicine Physician
  • Bemus Point, NY
National Provider Identifier
1922181767
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHAUTAUQUA MEDICAL PRACTICE, P.C.
Doing business as
Chautauqua Medical Practice, P.C.
Practice address
4936 Main St
Bemus Point, NY 14712
Phone
(716) 386-2414
Fax
(716) 386-2437
NPI assigned
Oct 23, 2006
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Paul S HolleyNPI 1225015696
Title
MD
Phone
(716) 386-2414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 204064 NY
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4936 Main St
Bemus Point, NY 14712

Mailing address

PO Box 470
4936 Main St
Bemus Point, NY 14712
Phone (716) 386-2414

Other identifiers 1

IdentifierTypeStateIssuer
01669929MedicaidNY

Other names 1

  • Chautauqua Medical Practice, P.C. Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101116000137 NY Part B Supplier - Clinic/Group Practice 5294920203 Receives reassigned benefits from 153 practitioners
Practice locations: Bemus Point, NY; Westfield, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0966363Chautauqua Medical Practice PC4936 Main St, Bemus Point, NY 14712Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

158 E Main St
Westfield, NY 14787
Phone (716) 326-4686

Practitioners & affiliated clinicians

Practitioners 158

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 158

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1922181767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470",
            "address_2": "4936 MAIN ST",
            "city": "BEMUS POINT",
            "state": "NY",
            "postal_code": "14712",
            "telephone_number": "716-386-2414",
            "fax_number": "716-386-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4936 MAIN ST",
            "city": "BEMUS POINT",
            "state": "NY",
            "postal_code": "14712",
            "telephone_number": "716-386-2414",
            "fax_number": "716-386-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAUTAUQUA MEDICAL PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "716-386-2414"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "204064",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01669929",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.ahn.org",
            "affiliation": "N",
            "address_1": "4936 Main St",
            "city": "Bemus Point",
            "state": "NY",
            "country_code": "US",
            "postal_code": "14712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Chautauqua Medical Practice, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemus Point, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.