1. Home
  2. Directory
  3. New York
  4. Jamestown
  5. Internal Medicine
  6. NPI Profile

GREAT LAKES PHYSICIAN PRACTICE PC
NPI 1730599176
Internal Medicine in Jamestown, NY

Active since May 07, 2014CLIA Certified · 3 labs
15 S MAIN ST, JAMESTOWN, NY 14701(716) 488-1877(716) 488-1986 Get Directions Write a Review

NPPES record last updated: February 3, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 3, 2020, Jan 23, 2020 (2 updates tracked since 2020).

About Great Lakes Physician Practice Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES PHYSICIAN PRACTICE PC (NPI 1730599176) is a healthcare organization registered as an internal medicine in Jamestown, New York and active in the NPI registry since May 2014. The organization holds 3 active CLIA laboratory certificates and lists Patricia Devlin, Sr.director, as its authorized official.

NPPES Registry Identity

NPI1730599176
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameGREAT LAKES PHYSICIAN PRACTICE PC
Location Address15 S MAIN STJamestown, NY 14701-6626
Mailing Address15 S Main StJamestown, NY 14701-6626 · (716) 488-1877 · Fax (716) 488-1986
Phone(716) 488-1877
Fax(716) 488-1986
Organization SubpartNo
Authorized OfficialPatricia DevlinSr.director · (412) 432-7469
Enumeration DateMay 7, 2014
Last NPPES UpdateFebruary 3, 20202 updates tracked since enumeration
✔ NPI 1730599176 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 11

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedEmergency MedicineTaxonomy 207P00000X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
Also ListedOtolaryngologyTaxonomy 207Y00000X
Also ListedSurgeryTaxonomy 208600000X
15 S MAIN ST, Jamestown, NY 14701
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0173900

Great Lakes Physician Practice PC Dba Glpp Family Practice · Jamestown, NY
Active · expires Mar 26, 2027
CLIA Number33D0173900
Laboratory TypePhysician Office
Certificate Effective DateJuly 18, 2018
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Katlin M. Ames
Laboratory Phone(716) 483-6700
Laboratory LocationGreat Lakes Physician Practice PC Dba Glpp Family Practice15 S Main St - Suite 150, Jamestown, NY 14701
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D0956645

Great Lakes Physician Practice PC Dba Glpp Internal Medicine · Jamestown, NY
Active · expires Mar 26, 2027
CLIA Number33D0956645
Laboratory TypePhysician Office
Certificate Effective DateMarch 6, 2024
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. John M. Lamancuso
Laboratory Phone(716) 483-0113
Laboratory LocationGreat Lakes Physician Practice PC Dba Glpp Internal Medicine15 South Main St - Suite 150, Jamestown, NY 14701
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 33D2275238

Great Lakes Physician Practice Ob-Gyn · Jamestown, NY
Active · expires Mar 26, 2027
CLIA Number33D2275238
Laboratory TypePhysician Office
Certificate Effective DateJanuary 18, 2023
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorMs. Brenda Munella
Laboratory Phone(716) 483-3520
Laboratory LocationGreat Lakes Physician Practice Ob-Gyn17 Sherman St, Jamestown, NY 14701
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DREW GIBSON
Physical Therapy Assistant
15 S MAIN ST, SUITE 220
JAMESTOWN, NY 14701
Chautauqua County (716) 488-2322
DR. ROBERT BAILEY MD
Family Medicine
15 S MAIN ST, SUITE 250 - FAMILY PRACTICE
JAMESTOWN, NY 14701
Chautauqua County (716) 488-1878
LEANDRA NICOLE ST. PIERRE DPT, CSCS
Physical Therapist
15 S MAIN ST, SUITE 220
JAMESTOWN, NY 14701
Chautauqua County (716) 488-2322
SHIRLEY J SWENSON FNP
Nurse Practitioner (Family)
15 S MAIN ST, SUITE 160
JAMESTOWN, NY 14701
Chautauqua County (716) 484-7107
KAROLEE HUTCHINSON PTA
Physical Therapy Assistant
15 S MAIN ST, SUITE 220
JAMESTOWN, NY 14701
Chautauqua County (716) 488-2322
TIMOTHY BROWN
Surgery
15 S MAIN ST, SUITE 170
JAMESTOWN, NY 14701
Chautauqua County (716) 483-1183
SHADEN ALFALLAY
Internal Medicine
15 S MAIN ST, SUITE 150 INTERNAL MEDICINE
JAMESTOWN, NY 14701
Chautauqua County (716) 484-8610
DR. GEORGE L SO M.D.
Internal Medicine (Cardiovascular Disease)
15 S MAIN ST, SUITE 110 - CARDIOLOGY
JAMESTOWN, NY 14701
Chautauqua County (716) 483-2320

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Physician Practice PC's NPI number?

The NPI number for Great Lakes Physician Practice PC is 1730599176. It was assigned to this organization in the NPPES registry on May 7, 2014.

Where is Great Lakes Physician Practice PC located?

Great Lakes Physician Practice PC is located at 15 S Main St, Jamestown, NY 14701. The listed phone number is (716) 488-1877.

What is Great Lakes Physician Practice PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Great Lakes Physician Practice PC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Great Lakes Physician Practice PC was last updated on February 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.