NPIMap

Individual provider Active NPI

Jeremy Daniel Lazorka, PA-C

  • Physician Assistant
  • Lock Haven, PA
National Provider Identifier
1043573066
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA055552 Issued in PA
Practice address
45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745
Phone
(570) 858-5328
Fax
(570) 858-5355
NPI assigned
Jun 25, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA055552 PA Primary

Addresses

Primary practice location

45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745

Mailing address

45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745-1237
Phone (570) 858-5328

Other identifiers 2

IdentifierTypeStateIssuer
6Z2639OtherPAMEDICARE PTAN
103271986-0004MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeremylazorkapac@fpc.medentdirect.com Health Information Exchange (HIE) FAMILY PRACTICE CENTER, PC

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
I20171009003365 PA Practitioner - Physician Assistant 7214230689 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Haven Health and Wellness LLCGroup PAC ID 6608317029, 4 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

45 Bellefonte Ave
Suite 2
Lock Haven, PA 17745-1237
Phone (570) 971-7121

Hospital & facility affiliations

  • Upmc Home Healthcare Home health agency, Williamsport, PA, CCN 397006
  • Residential Home Health of NC PA, LLC Home health agency, Lewisburg, PA, CCN 398144
  • Upmc Williamsport Hospital, Williamsport, PA, CCN 390045
  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA055552PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC Physician Assistant CurrentSince Sep 1, 2017 Accepting new patients

Locations

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

7133 Nittany Valley Dr
Mill Hall, PA 17751
Phone (570) 726-7992

Interoperability endpoints

  • Direct secure messaging: jeremylazorkapac@havenhealth.medentdirect.com

Organizations & group practices 2

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

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1043573066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BELLEFONTE AVE",
            "address_2": "SUITE #2",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177451237",
            "telephone_number": "570-858-5328",
            "fax_number": "570-858-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 BELLEFONTE AVE",
            "address_2": "SUITE #2",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "17745",
            "telephone_number": "570-858-5328",
            "fax_number": "570-858-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZORKA",
        "first_name": "JEREMY",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2024-11-01",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "6Z2639",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103271986-0004",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeremylazorkapac@fpc.medentdirect.com",
            "affiliation": "Y",
            "affiliationName": "FAMILY PRACTICE CENTER, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "529 High St",
            "city": "Lock Haven",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177453029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lock Haven, PA

Sources for this page

Verify at the official NPI Registry.