| Jordan at Ccia | |
|
120 N Main St Suite 11 Canandaigua NY 14424-1258 | |
| (585) 396-6980 | |
| Not Available |
| Full Name | Jordan at Ccia |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 N Main St, Canandaigua, New York |
| Authorized Official Name and Position | Bridgette Wiefling (PRESIDENT/CEO) |
| Authorized Official Contact | 5854232878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan at Ccia 82 Holland Street Rochester NY 14605-2131 | Jordan at Ccia 120 N Main St Suite 11 Canandaigua NY 14424-1258 Ph: (585) 396-6980 |
| NPI Number | 1649529678 |
|---|---|
| Provider Enumeration Date | 09/06/2012 |
| Last Update Date | 09/07/2012 |
| Medicare PECOS PAC ID | 8729079785 |
|---|---|
| Medicare Enrollment ID | O20040519001335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649529678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| Provider Name | Ingrid Wohlgemuth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770523623 PECOS PAC ID: 6406759141 Enrollment ID: I20040129000792 |
| Provider Name | Anne Marie Blanchard |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881630184 PECOS PAC ID: 2769476316 Enrollment ID: I20040414001263 |
| Provider Name | Sandra L Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801810874 PECOS PAC ID: 5092791137 Enrollment ID: I20040628001592 |
| Provider Name | Basya V Herbert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912943812 PECOS PAC ID: 6709848724 Enrollment ID: I20041102000510 |
| Provider Name | Steven M Fine |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1780682351 PECOS PAC ID: 5395759120 Enrollment ID: I20060201000387 |
| Provider Name | Katherine P O Hanlon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134152275 PECOS PAC ID: 5698781094 Enrollment ID: I20060222000386 |
| Provider Name | Eric Alan Kerr |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760421341 PECOS PAC ID: 6002881315 Enrollment ID: I20060905000416 |
| Provider Name | Jessica L Martin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982623203 PECOS PAC ID: 2567564958 Enrollment ID: I20070305000323 |
| Provider Name | Elizabeth J Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861415838 PECOS PAC ID: 7214022037 Enrollment ID: I20071009000068 |
| Provider Name | Mary C Angerame |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093886830 PECOS PAC ID: 4486743861 Enrollment ID: I20071207000808 |
| Provider Name | Roger J Chapman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346439544 PECOS PAC ID: 9133219660 Enrollment ID: I20071220000137 |
| Provider Name | Jeffrey J Harp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659308260 PECOS PAC ID: 6103902176 Enrollment ID: I20080401000225 |
| Provider Name | Linda Levita Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720249147 PECOS PAC ID: 4587736921 Enrollment ID: I20080701000029 |
| Provider Name | Diane S Morse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770552341 PECOS PAC ID: 1850465303 Enrollment ID: I20080801000327 |
| Provider Name | Joseph G Diprima |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1932261914 PECOS PAC ID: 9931235736 Enrollment ID: I20100331000752 |
| Provider Name | Nashat S Atalla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245208065 PECOS PAC ID: 8921020934 Enrollment ID: I20110516000194 |
| Provider Name | Sakinah N Miller |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538173679 PECOS PAC ID: 1557530318 Enrollment ID: I20110811000549 |
| Provider Name | Faith Debra Adams |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316914609 PECOS PAC ID: 7911171954 Enrollment ID: I20111201000027 |
| Provider Name | Kevin a Fiscella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144332818 PECOS PAC ID: 2769622562 Enrollment ID: I20130627000665 |
| Provider Name | Thecla I Obi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679801633 PECOS PAC ID: 0840424743 Enrollment ID: I20140224001499 |
| Provider Name | Chelsie M Kleeh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750706990 PECOS PAC ID: 0648402982 Enrollment ID: I20140421000196 |
| Provider Name | Melanie Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609142587 PECOS PAC ID: 3274758826 Enrollment ID: I20140715002134 |
| Provider Name | Thomas Robert Gregg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639339146 PECOS PAC ID: 2365760899 Enrollment ID: I20150414001280 |
| Provider Name | Rosamond Reffell-pugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891087771 PECOS PAC ID: 7618256421 Enrollment ID: I20161118001933 |
| Provider Name | Lawrence Shawndel Brumfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750695615 PECOS PAC ID: 8426326406 Enrollment ID: I20170615001075 |
| Provider Name | Sarah Elizabeth Hudson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740417039 PECOS PAC ID: 8820233364 Enrollment ID: I20170801003125 |
| Provider Name | Danielle B Fleissig |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073932315 PECOS PAC ID: 8628349008 Enrollment ID: I20170803000009 |
| Provider Name | Colleen a Obrien |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1487162533 PECOS PAC ID: 7113287137 Enrollment ID: I20180212001238 |
| Provider Name | Karen Nicole Finklea |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891260683 PECOS PAC ID: 2365796430 Enrollment ID: I20181109000212 |
| Provider Name | Kelley-anne C Klein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073928370 PECOS PAC ID: 1355650904 Enrollment ID: I20181220000046 |
| Provider Name | Emily Jade Zeafla |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518439116 PECOS PAC ID: 2466793575 Enrollment ID: I20190417002044 |
| Provider Name | Kaitlyn Erin Kennedy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255997581 PECOS PAC ID: 4789915984 Enrollment ID: I20191018000432 |
| Provider Name | Kimberlie a Noyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700429461 PECOS PAC ID: 1850729658 Enrollment ID: I20200310000124 |
| Provider Name | Avellina Ihuaku Okafor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073159679 PECOS PAC ID: 8820426562 Enrollment ID: I20200312000485 |
| Provider Name | Caroline RB Donohue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730614843 PECOS PAC ID: 6204189194 Enrollment ID: I20200612000860 |
| Provider Name | Nicholas D David |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740715564 PECOS PAC ID: 5991075962 Enrollment ID: I20200914000188 |
| Provider Name | Nina G Piazza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659805026 PECOS PAC ID: 5294005054 Enrollment ID: I20200919000010 |
| Provider Name | Neelam Agarwal |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396042107 PECOS PAC ID: 2961684717 Enrollment ID: I20201103000262 |
| Provider Name | Lisa M Denmark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912528142 PECOS PAC ID: 6002226016 Enrollment ID: I20201103001334 |
| Provider Name | Lillian a Riley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730709296 PECOS PAC ID: 7416360995 Enrollment ID: I20201229002414 |
| Provider Name | Christina Humbert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235766312 PECOS PAC ID: 9739593617 Enrollment ID: I20210204002100 |
| Provider Name | Jaslynn Renee Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790350890 PECOS PAC ID: 1052701976 Enrollment ID: I20211208003505 |
| Provider Name | Sarah M Tiggelaar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376806851 PECOS PAC ID: 7113172651 Enrollment ID: I20230113001633 |
| Provider Name | Danica Luc |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134877533 PECOS PAC ID: 1355706789 Enrollment ID: I20230508001377 |
| Provider Name | Hemant Kalia |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1689879959 PECOS PAC ID: 1355574708 Enrollment ID: I20240106000384 |
| Provider Name | Mary E Sherman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255118345 PECOS PAC ID: 8325483126 Enrollment ID: I20240304000442 |
| Provider Name | Tianrae Chu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588240337 PECOS PAC ID: 9133523210 Enrollment ID: I20240509002112 |
| Provider Name | Nicholas Ensinger Antos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225614977 PECOS PAC ID: 5395149470 Enrollment ID: I20250121000206 |
| Provider Name | Jean Lee |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1982260493 PECOS PAC ID: 1456680057 Enrollment ID: I20251107002374 |
Fingerlakes Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 241 Parrish St, Suite B, Canandaigua, NY 14424 Phone: 585-394-8170 Fax: 585-394-8173 |
Clemensen Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 181 S Main St, Suite 5, Canandaigua, NY 14424 Phone: 866-269-4810 Fax: 866-269-4810 |
Laurel a Dallmeyer Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 495 N Main St, Canandaigua, NY 14424 Phone: 585-393-3515 Fax: 585-393-3515 |
Bloomfield Family Practice, P.C. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6032 Woodvine Rise, Canandaigua, NY 14424 Phone: 585-202-5022 |
Canandaigua Medical Group, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 335 Parrish St, Canandaigua, NY 14424 Phone: 585-393-2888 Fax: 585-396-9275 |
Lake Country Family Medicine, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 S Main St, Suite G, Canandaigua, NY 14424 Phone: 585-394-1875 Fax: 866-285-9069 |