NPIMap

Organization Active NPI

Robert Erickson DO and Jennifer Erickson DO LLC

  • Family Medicine Physician
  • Orchard Park, NY
National Provider Identifier
1992866990
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
175824 Issued in NY
Legal business name
ROBERT ERICKSON DO AND JENNIFER ERICKSON DO LLC
Practice address
3671 Southwestern Blvd St 213
Orchard Park, NY 14127
Phone
(716) 667-2673
Fax
(716) 662-5226
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Dr. Robert J Erickson, DONPI 1093771396
Title
President
Phone
(716) 667-2673

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 175824 NY Primary

Addresses

Primary practice location

3671 Southwestern Blvd St 213
Orchard Park, NY 14127

Mailing address

3671 Southwestern Blvd St 213
Orchard Park, NY 14127
Phone (716) 667-2673

Other identifiers 1

IdentifierTypeStateIssuer
01781759MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050603000703 NY Part B Supplier - Clinic/Group Practice 5991748626 Receives reassigned benefits from 18 practitioners
Practice locations: Orchard Park, NY

National Provider Directory

National Provider Directory

Locations

3671 Southwestern Blvd
#213
Orchard Park, NY 14127
Phone (716) 662-7008

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1992866990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3671 SOUTHWESTERN BLVD ST 213",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "14127",
            "telephone_number": "716-667-2673",
            "fax_number": "716-662-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3671 SOUTHWESTERN BLVD ST 213",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "14127",
            "telephone_number": "716-667-2673",
            "fax_number": "716-662-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT ERICKSON DO AND JENNIFER ERICKSON DO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-667-2673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "175824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01781759",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orchard Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.