NPIMap

Individual provider Active NPI

Michael A. Kovalick, D.O.

  • Family Medicine Physician
  • Dallas, PA
National Provider Identifier
1063472389
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009120L Issued in PA
Practice address
114 LT Michael Cleary Dr
Dallas, PA 18612-1649
Phone
(570) 675-2000
Fax
(570) 675-1806
NPI assigned
Mar 23, 2006
Last updated
Aug 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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 OS009120L PA Primary

Addresses

Primary practice location

114 LT Michael Cleary Dr
Dallas, PA 18612-1649

Mailing address

100 N Academy Ave
Danville, PA 17822-3034
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
001705959MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkovalick65570@direct.geisinger.edu Direct

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
I20050831000709 PA Practitioner - Family Practice 5799717658 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Caring Community Health CenterGroup PAC ID 5698004588, 46 clinicians

Practice addresses (Care Compare)

114 LT Michael Cleary Dr
Dallas, PA 18612-1649
Phone (570) 675-2000

175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040
Phone (570) 829-2621

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS009120LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Family Medicine Current Accepting new patients
Geisinger Clinic CurrentSince Jul 1, 2002 Accepting new patients
Caring Community Health Center Current Accepting new patients
Caring Community Health Center CurrentSince Oct 1, 2019 Accepting new patients
Caring Community Health Center CurrentSince Oct 1, 2019 Accepting new patients
Geisinger Clinic Family Medicine CurrentSince Jul 1, 2002 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

114 Lt Michael Cleary Dr
Dallas, PA 18612
Phone (570) 255-1178

40 Dallas Village Shopping Ctr
Dallas, PA 18612
Phone (570) 674-9001

100 N Academy Ave
Danville, PA 17822

426 Airport Rd
Ste 125
Hazle Township, PA 18202
Phone (570) 829-2621

499 Wyoming Ave
Kingston, PA 18704
Phone (570) 283-2161

12 Kirby Ave
Mountain Top, PA 18707
Phone (570) 474-5978

57 N Main St
Pittston, PA 18640
Phone (570) 602-5620

125 Scranton Pocono Hwy
Scranton, PA 18505
Phone (570) 342-8500

531 Mt Pleasant Dr
Scranton, PA 18503
Phone (570) 342-8500

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702
Phone (570) 821-0808

Organizations & group practices 7

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 58

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

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1063472389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178223034",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 LT MICHAEL CLEARY DR",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121649",
            "telephone_number": "570-675-2000",
            "fax_number": "570-675-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVALICK",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009120L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001705959",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkovalick65570@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "114 Lt Michael Cleary Dr",
            "city": "Dallas",
            "state": "PA",
            "country_code": "US",
            "postal_code": "186121649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dallas, PA

Sources for this page

Verify at the official NPI Registry.