Commonwealth Physician Network LLC
Organization Active NPI Internal Medicine Physician · Kingston, PA
NPI 1003238635 · NPPES record last updated Jul 9, 2025
Key facts
- NPI
- 1003238635
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- COMMONWEALTH PHYSICIAN NETWORK LLC
- Practice address
- 610 Wyoming Ave
Kingston, PA 18704-3702 - Phone
- (570) 288-5441
- Fax
- (570) 288-9613
- NPI assigned
- Jan 16, 2014
- Organization subpart
- No
Authorized official
- Name
- Kristina Music
- Title
- Director Provider Enrollment
- Phone
- (877) 892-9815
Practitioners 96
-
Marie Juliette Adajar, M.D.
-
Essam M Almeky, MD
-
Javid Rohullah Amini, M.D.
-
Michael Vito Brown, M.D.
-
Jacqueline Cain, DO
-
Jodi A Calabro, CRNP
-
Devin Carey, M.D.
-
Juan J Derojas, M.D.
-
Daniel John Dudrick, M.D.
-
Jill Ann Ferretti, CRNP
-
Sanjeev Garg, M.D.
-
Michael J Grasso, MD
-
Ron Konecke, M.D.
-
Matthew Nicholas Kozicki, M.D.
-
Gary Langieri, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D0193231 | Commonwealth Health Physician Network | Certificate of waiver | Feb 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140617000549 | PA | Part B Supplier - Clinic/Group Practice | 2668696592 |
Receives reassigned benefits from 89 practitioners Practice locations: Plains, PA; Nanticoke, PA; Scranton, PA; Shavertown, PA; Tunkhannock, PA; Wilkes Barre, PA; Pittston, PA; Mountain Top, PA… |
National Provider Directory
Locations
10 Dundaff St
Carbondale, PA 18407
Phone (570) 281-3366
1000 Meade St
Ste 101
Dunmore, PA 18512
Phone (570) 504-2500
1000 Meade St
Ste 106
Dunmore, PA 18512
Phone (570) 207-0171
190 Welles St
Ste 2
Forty Fort, PA 18704
Phone (570) 288-0400
270 Pierce St
Ste 201
Kingston, PA 18704
Phone (570) 331-2222
239 S Mountain Blvd
Ste 101
Mountain Top, PA 18707
4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939
1099 S Township Blvd
Ste C
Pittston, PA 18640
672 S River St
Ste 101
Plains, PA 18705
Phone (570) 552-7150
670 S River St
Ste 201
Plains, PA 18705
Phone (570) 408-0410
670 S River St
Ste 203
Plains, PA 18705
Phone (570) 552-7110
746 Jefferson Ave
Ste 303
Scranton, PA 18510
Phone (570) 207-0433
5950 Sr 6
Fl 4
Tunkhannock, PA 18657
Phone (570) 836-6808
6011 Sr 6
Tunkhannock, PA 18657
Phone (570) 836-7600
5950 Sr 6
Fl 3
Tunkhannock, PA 18657
Phone (570) 587-7817
263 Carbondale Rd
Waymart, PA 18472
Phone (570) 488-5444
545 N River St
Fl 3
Wilkes Barre, PA 18702
Phone (570) 552-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Surgery Physician |
208600000X | |||
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
208G00000X |
Addresses
Primary practice location
610 Wyoming Ave
Kingston, PA 18704-3702
Mailing address
4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102897748 0001 | Medicaid | PA |
Other providers in Kingston, PA
- Cohen & Haydu Chiropractic Clinic, PC
- Cohen Chiropractic Clinic, P.C.
- Richard Cohen
- Christa A Colaizzi
- Aprile B Coleman
- Compass Home Health & Rehab, LLC
- Compassionate Home Care of Northeastern PA, LLC
- Complete Home Care, Inc
- Comprehensive Family and Cosmetic Dental Center
- Malcolm L. Conway Jr.
All providers in Kingston, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.