Individual provider Active NPI

Jeremy J Killion, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Buffalo, NY
National Provider Identifier
1972751816
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
250163 Issued in NY
Practice address
818 Ellicott St
Buffalo, NY 14203-1021
Phone
(716) 323-0220
Fax
(716) 323-0293
NPI assigned
Sep 4, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 250163 NY
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 250163 NY Primary

Addresses

Primary practice location

818 Ellicott St
Buffalo, NY 14203-1021

Mailing address

1001 Main St FL 5
Buffalo, NY 14203-1009
Phone (716) 323-0220

Other identifiers 1

IdentifierTypeStateIssuer
03038740MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081206000134 NY Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 3274694401 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
250163NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University at Buffalo Pediatric Associates Inc Pediatrics CurrentSince Oct 1, 2008 Accepting new patients

Locations

1001 Main St
Fl 5
Buffalo, NY 14203
Phone (716) 323-0031

818 Ellicott St
Buffalo, NY 14203
Phone (716) 323-2000

1404 Sweet Home Rd
Buffalo, NY 14228
Phone (716) 932-6060

1404 Sweet Home Rd
Ste 56
Buffalo, NY 14228
Phone (716) 639-9361

219 Bryant St
Buffalo, NY 14222
Phone (716) 878-7000

Organizations & group practices 1

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": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1972751816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST FL 5",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031009",
            "telephone_number": "716-323-0220",
            "fax_number": "716-323-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 ELLICOTT ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031021",
            "telephone_number": "716-323-0220",
            "fax_number": "716-323-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLION",
        "first_name": "JEREMY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-04",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "250163",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "250163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03038740",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.