Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Justin Potter Pendergrast, PA-C

Individual provider Physician Assistant · NPI 1972692887

Mr. Justin Potter Pendergrast, PA-C is a Physician Assistant in Albany, New York. Qualified in 2003, 23 years ago. Practices with Ellis Hospital, a 252-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
23
Licensed in
NY
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

43 New Scotland Ave
Albany, NY 12208-3412
Phone: (518) 262-6575
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 009621 (NY)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 009621 (NY)

Record details

NPI number1972692887
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 11, 2006
Last updated in NPPESJuly 15, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Ellis Hospital — 252 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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