Adolph Michael Wychulis, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD418365 Issued in PA

Practice address

24 S Main St
Shenandoah, PA 17976-2331

Phone

(570) 462-1033

Fax

(570) 462-1171

NPI assigned

Aug 29, 2005

Last updated

Mar 18, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Main Street Medical Center Inc

  • Internal Medicine Physician
  • Shenandoah, PA
  • NPI 1063561041
  NPD (past) Authorized official

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205798400000",
    "number": "1023001617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 S MAIN ST",
            "city": "SHENANDOAH",
            "state": "PA",
            "postal_code": "179762331",
            "telephone_number": "570-462-1033",
            "fax_number": "570-462-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S MAIN ST",
            "city": "SHENANDOAH",
            "state": "PA",
            "postal_code": "179762331",
            "telephone_number": "570-462-1033",
            "fax_number": "570-462-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCHULIS",
        "first_name": "ADOLPH",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-29",
        "last_updated": "2008-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD418365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sasha W Sherry
• Smnrc, LP (Shenandoah Manor Nursing Center)
• Yalixsa Then, FNP-BC
• Trinity Mission of Shenandoah Heights, LLC (Trinity Mission Health & Rehab of Shenandoah Heights)
• Sherley Vasquez, LPT
• Logan J. Zeitler, MS, OTR/L

• Specialist in Shenandoah, PA
• Providers in Shenandoah, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.