Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Bobbie Rae Faivus Vangorder, PA

Individual provider Medical Physician Assistant · NPI 1154630366

Mrs. Bobbie Rae Faivus Vangorder, PA is a Physician Assistant in Oswego, New York. Qualified in 2010, 16 years ago. Practices with Physician Care PC, a 77-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
16
Licensed in
NY
In the registry since
2010
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

110 W Utica St
Oswego, NY 13126-3047
Phone: (315) 349-5537
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 College Plaza, Oswego, NY 13126-1731 — (315) 342-0030

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 014226 (NY)

Record details

NPI number1154630366
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 5, 2010
Last updated in NPPESMarch 29, 2023
Certification dateMarch 29, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Physician Care Pc — 77 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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