NPIMap

Individual provider Active NPI

Daniel John Dudrick, M.D.

  • Family Medicine Physician
  • Mountain Top, PA
National Provider Identifier
1003825506
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD438396 Issued in PA
Practice address
239 S Mountain Blvd
Suite 100
Mountain Top, PA 18707-1911
Phone
(570) 474-9300
Fax
(570) 474-0962
NPI assigned
Aug 5, 2006
Last updated
Nov 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD438396 PA Primary

Addresses

Primary practice location

239 S Mountain Blvd
Suite 100
Mountain Top, PA 18707-1911

Mailing address

610 Wyoming Ave
Kingston, PA 18704-3702
Phone (570) 288-5441

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address daniel.dudrick.1@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091113000276 PA Practitioner - Family Practice 6507865623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Perelman School of Med at the University of Pennsylvania, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

239 S Mountain Blvd
Suite 100
Mountain Top, PA 18707-1968
Phone (570) 474-9300

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD438396PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC Family Medicine CurrentSince Nov 15, 2023 Accepting new patients

Locations

610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441

610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032

239 S Mountain Blvd
Ste 100
Mountain Top, PA 18707
Phone (570) 474-9300

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

Networks

  • devoted network organization-8ee96498-f86e-45f6-9fc9-a0f06c1636f9
  • devoted network organization-2d523d8e-e8f9-454a-bcd3-333df65bdbe8
  • devoted network organization-9f3dfbd3-4aa6-4c92-8e71-9c4ed35ce037

Interoperability endpoints

  • Direct secure messaging: daniel.dudrick.1@21771.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 54

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 54

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1003825506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702",
            "telephone_number": "570-288-5441",
            "fax_number": "570-288-5842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 S MOUNTAIN BLVD",
            "address_2": "SUITE 100",
            "city": "MOUNTAIN TOP",
            "state": "PA",
            "postal_code": "187071911",
            "telephone_number": "570-474-9300",
            "fax_number": "570-474-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDRICK",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD438396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "daniel.dudrick.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "amrdirectaddress",
            "address_1": "239 S Mountain Blvd",
            "address_2": "Suite 100",
            "city": "Mountain Top",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187071911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mountain Top, PA

Sources for this page

Verify at the official NPI Registry.