Jason Robert Pericak (NPI# 1689823411, PAC ID# 5496800583) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1689823411 |
| PAC ID by PECOS | 5496800583 |
| Professional Enrollment ID | I20100824001000 |
| Full Name | Jason Robert Pericak |
| Organization Legal Name | GREAT LAKES MEDICAL IMAGING LLC |
| Address |
3850 Saunders Settlement Rd Sanborn NY 14132-9128 |
| Phone Number | 7168982840 |
| Gender | M |
| Medical School | STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE |
| Graduation Year | 2004 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 2163681859 |
| Number of Group Practice Members | 28 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 330005 | KALEIDA HEALTH |
| 330163 | EASTERN NIAGARA HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 100 High St, Buffalo, NY 14203-1126 | 7168592954 | WESTERN NY RADIOLOGY ASSOCIATES LLC |
| 3085 Harlem Rd, Suite 150, Cheektowaga, NY 14225-2593 | 7168445300 | GREAT LAKES MEDICAL IMAGING LLC |
| 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 | 7168982840 | GREAT LAKES MEDICAL IMAGING LLC |
| 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 | 7168364646 | GREAT LAKES MEDICAL IMAGING LLC |
| Organization Legal Name | GREAT LAKES MEDICAL IMAGING LLC |
| Physicians | 31 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Phillip Baum | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| Gregory S Shields | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| James J Rinaldi | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Roseanne Oliverio | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| Thomas Bevilacqua | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Douglas S Drumsta | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| John R Mcgrath | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| Michael F Tabone | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| Kenneth D Pearsen | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Omar Z Chohan | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 199 Park Club Ln, Suite 300, Williamsville, NY 14221-5269 |
| Street Address |
3850 SAUNDERS SETTLEMENT RD |
| City | SANBORN |
| State | NY |
| Zip | 14132-9128 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Gregory S Shields | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| James J Rinaldi | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Thomas Bevilacqua | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Surjeet S Pohar | Radiation Oncology | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Kenneth D Pearsen | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Gail E Stokoe | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Brian D Rambarran | Urology | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Katrina Michelle Vankouwenberg | Physician Assistant | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Matthew Stephen Thurman | Radiation Oncology | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Andrew T Dunn | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dhiren K Shah | Radiation Oncology | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Anthony G Notino | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Emily A Levandusky | Physician Assistant | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Jasbeer S Makhija | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Jaime Fetes | Physician Assistant | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Leanna Alexis Dibisceglie | Physician Assistant | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Daniel R Jacobson | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| William R Hampton | Diagnostic Radiology | Great Lakes Medical Imaging LLC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Gregory A Czajka | Physician Assistant | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| John M Roehmholdt | Urology | Great Lakes Physician PC | 3850 Saunders Settlement Rd, Sanborn, NY 14132-9128 |
| Find all physicians in zip 14132 | |||
| City | SANBORN |
| Zip Code | 14132 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | SANBORN + DIAGNOSTIC RADIOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.