THERESA D O'DOHERTY NP
NPI 1043529597
Nurse Practitioner - Family in Buffalo, NY

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

NPI Status: Active since October 01, 2010

Contact Information

701 SENECA ST STE 646C
BUFFALO, NY
ZIP 14210
Phone: (716) 995-4450

NPPES record last updated: October 28, 2019. Verified against the NPPES registry weekly; last sync: July 12, 2026.

Record update history: Oct 28, 2019, Mar 17, 2018, Oct 25, 2017 (3 updates tracked since 2017).

Table of Contents

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Secondary Locations
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 17
Nurse Practitioner
Family
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About THERESA O'DOHERTY

This page provides the complete NPI Profile along with additional information for Theresa O'doherty, a provider established in Buffalo, New York with a medical specialization in Nurse Practitioner, focusing in family and more than 17 years of experience. The healthcare provider is registered in the NPI registry with number 1043529597 assigned on October 2010. The practitioner's primary taxonomy code is 363LF0000X with license number 2258900 (MA). The provider is registered as an individual and her NPI record was last updated 7 years ago.

NPI: 1043529597
Provider Name: THERESA D O'DOHERTY NP
Gender: Female
Entity Type: Individual
Location Address: 701 SENECA ST STE 646C BUFFALO, NY 14210
Location Phone: (716) 995-4450
Mailing Address: 26 QUEEN STREET WORCESTER, CT 01610
Mailing Phone: (508) 860-7706
Mailing Fax: (508) 796-7014
Medical School Name: OTHER
Graduation Year: 2010
Is Sole Proprietor?: No
Enumeration Date: 10-01-2010
Last Update Date: 10-28-2019
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A nurse practitioner (NP) like Theresa O'doherty is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

Secondary Locations

20 Hope Ave Ste G 01
Waltham, MA 02453
(781) 788-0005
26 Queen St
Worcester, MA 01610
(508) 860-7700

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Nurse Practitioner Family
Taxonomy Code: 363LF0000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 2258900
License State: MA

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Anthem Blue Cross and Blue Sheld

Anthem Bronze Preferred Blue PPO 6000/20%/8000 w/HSA - PPO
Anthem Bronze Preferred Blue PPO 7000/50%/8000 w/HSA - PPO
Anthem Bronze Preferred Blue PPO 7500/30%/10000 Value - PPO
Anthem Bronze Preferred Blue PPO 8500/50%/9200 - PPO
Anthem Gold Preferred Blue PPO 1000/20%/7500 - PPO
Anthem Gold Preferred Blue PPO 2000/0%/6500 RxD - PPO
Anthem Gold Preferred Blue PPO 2000/10%/4600 w/HSA - PPO
Anthem Gold Preferred Blue PPO 2000/10%/7500 - PPO
Anthem Gold Preferred Blue PPO 2000/20%/4600 w/HSA - PPO
Anthem Gold Preferred Blue PPO 3000/0%/7500 RxD - PPO
Anthem Gold Preferred Blue PPO 500/30%/9000 - PPO
Anthem Platinum Preferred Blue PPO 250/10%/3500 - PPO
Anthem Silver Preferred Blue PPO 2500/30%/10000 Value - PPO
Anthem Silver Preferred Blue PPO 3000/30%/9000 Value - PPO
Anthem Silver Preferred Blue PPO 3500/20%/10000 - PPO
Anthem Silver Preferred Blue PPO 3500/20%/7250 w/HSA - PPO
Anthem Silver Preferred Blue PPO 4000/0%/9000 - PPO
Anthem Silver Preferred Blue PPO 4000/0%/9000 RxD - PPO
Anthem Silver Preferred Blue PPO 4000/10%/7250 w/HSA - PPO
Anthem Silver Preferred Blue PPO 4000/20%/8500 - PPO

Anthem Blue Cross and Blue Shield

Anthem Bronze Pathway X Enhanced 6000/35% HSA - HMO
Anthem Bronze Pathway X Enhanced 7000/0% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Bronze Pathway X Enhanced 7500/50% ($0 Virtual PCP + $0 Select Drugs) Standard - HMO
Anthem Catastrophic Pathway X Enhanced - HMO
Anthem Gold Pathway X Enhanced 1200/20% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Gold Pathway X Enhanced 2000/25% ($0 Virtual PCP + $0 Select Drug) Standard - HMO
Anthem Gold Pathway X Enhanced 700/40% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Heart Healthy Bronze Pathway X Enhanced 6000/40% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Heart Healthy Silver Pathway X Enhanced 4000/0% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Silver Pathway X Enhanced 4500/20% HSA - HMO
Anthem Silver Pathway X Enhanced 5500/20% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Silver Pathway X Enhanced 6000/40% ($0 Virtual PCP + $0 Select Drugs) Standard - HMO
Anthem Bronze Access Blue New England HMO 6000/20%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7500/30%/10000 Value - HMO
Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
Anthem Bronze Pathway X HMO 6000/20%/8000 w/HSA - HMO
Anthem Bronze Pathway X HMO 7000/50%/8000 w/HSA - HMO
Anthem Bronze Pathway X HMO 7500/30%/10000 Value - HMO
Anthem Bronze Pathway X HMO 8500/50%/9200 - HMO

WellSense Health Plan

WellSense Clarity NH Bronze 6500 HSA + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Bronze 7500 HSA + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Bronze 7600 HSA + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Gold 2000 + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Silver 0 Deductible + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Silver 3400 + $0 Rx List + 24/7 Nurse Advice - HMO
WellSense Clarity NH Silver 6000 + $0 Rx List + 24/7 Nurse Advice - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Theresa O'doherty is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Theresa O'doherty is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 1951583905
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20200206000055, I20231121003104, I20231121003216, I20231121003360, I20240404003417, I20250923003877
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional
Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes
Telehealth originating site facility fee

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.23 for a new patient copayment and $24.27 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 14210 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $84.93
Minimum New Patient Price $54.87
Maximum New Patient Price $166.88

Average New Patient Copayment $21.23
Minimum New Patient Copayment $13.71
Maximum New Patient Copayment $41.72

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $97.08
Minimum Established Patient Price $17.54
Maximum Established Patient Price $136.14

Average Established Patient Copayment $24.27
Minimum Established Patient Copayment $4.38
Maximum Established Patient Copayment $34.03

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1043529597, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 8

Pos 4

Unchanged

Pos 5

Doubled → 10 → 1 + 0

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 4 → 8 5 → 10 → 1 9 → 18 → 9 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 8 + 3 + 1 + 0 + 2 + 1 + 8 + 5 + 1 + 8 + 24 = 63

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 63 is 70. The difference is the calculated check digit.

70 - 63 = 7

This NPI is valid

The calculated check digit is 7, which matches the last digit of 1043529597.