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

Thomas Bevilacqua, MD

Individual provider Diagnostic Radiology Physician · NPI 1093094005

Thomas Bevilacqua, MD is a Diagnostic Radiology in Williamsville, New York. Graduated from State University of New York at Buffalo School of Medicine in 2011, 15 years ago. Practices with Great Lakes Medical Imaging LLC, a 42-clinician group and accepts Medicare assignment. Licensed in Illinois and New York.

Years since qualifying
15
Trained at
State University of New York at Buffalo School of Medicine
Licensed in
IL, NY
In the registry since
2011
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

111 N Maplemere Rd Ste 120
Williamsville, NY 14221-3178
Phone: (716) 836-4646
Fax: (716) 836-4696
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 288107 (NY)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 125.060174 (IL)

Record details

NPI number1093094005
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 8, 2011
Last updated in NPPESAugust 18, 2023
Certification dateAugust 18, 2023

Medicare enrollment

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

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolSTATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Great Lakes Medical Imaging Llc — 42 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Williamsville