NPIMap

Individual provider Active NPI

Philip Douglas Graham, PA

  • Physician Assistant
  • North Chili, NY
National Provider Identifier
1922289107
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
012180 Issued in NY
Practice address
4201 Buffalo Road
Suite 1
North Chili, NY 14514-1256
Phone
(585) 594-5995
Fax
(585) 594-5995
NPI assigned
Nov 16, 2007
Last updated
Jul 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 012180 NY Primary
Surgical Physician Assistant 363AS0400X 012180 NY

Addresses

Primary practice location

4201 Buffalo Road
Suite 1
North Chili, NY 14514-1256

Mailing address

PO Box 505
North Chilli, NY 14514-0505
Phone (585) 594-5995

Other identifiers 1

IdentifierTypeStateIssuer
02942809MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Janene.Baase@rochesterregional.org

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
I20071226000402 NY Practitioner - Physician Assistant 4183714439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Carolina School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Churchville-Chili Family Medicine LLCGroup PAC ID 5294957874, 12 clinicians

Practice addresses (Care Compare)

4201 Buffalo Rd
North Chili, NY 14514-1256
Phone (585) 594-5995

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
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
012180NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Unity Hospital of Rochester CurrentSince Oct 23, 2007 Accepting new patients

Locations

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

Interoperability endpoints

  • Direct secure messaging: dgraham@ccfm.medentdirect.com
  • Direct secure messaging: janene.baase@rochesterregional.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1922289107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505",
            "city": "NORTH CHILLI",
            "state": "NY",
            "postal_code": "145140505",
            "telephone_number": "585-594-5995",
            "fax_number": "585-594-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 BUFFALO ROAD",
            "address_2": "SUITE 1",
            "city": "NORTH CHILI",
            "state": "NY",
            "postal_code": "145141256",
            "telephone_number": "585-594-5995",
            "fax_number": "585-594-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "PHILIP",
        "middle_name": "DOUGLAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-16",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012180",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "012180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02942809",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Janene.Baase@rochesterregional.org",
            "affiliation": "N",
            "address_1": "4201 Buffalo Road",
            "address_2": "Suite 1",
            "city": "North Chili",
            "state": "NY",
            "country_code": "US",
            "postal_code": "145141256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Chili, NY

Sources for this page

Verify at the official NPI Registry.