Individual provider Active NPI

Charles E Lubash, PA-C

  • Physician Assistant
  • Dunmore, PA
National Provider Identifier
1063554525
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA-052918 Issued in PA
Practice address
1100 Meade Street
Dunmore, PA 18512-3169
Phone
(570) 342-3675
Fax
(570) 342-3316
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA052918 PA
Physician Assistant 363A00000X MA-052918 PA Primary

Addresses

Primary practice location

1100 Meade Street
Dunmore, PA 18512-3169

Mailing address

1100 Meade St
Dunmore, PA 18512-3169
Phone (570) 342-3675

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100420000758 PA Practitioner - Physician Assistant 8628160777 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA-052918PAMDPhysician Assistant
MA052918PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Emergency Care, PC Physician Assistant Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361491200000",
    "number": "1063554525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MEADE ST",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185123169",
            "telephone_number": "570-342-3675",
            "fax_number": "570-342-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MEADE STREET",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185123169",
            "telephone_number": "570-342-3675",
            "fax_number": "570-342-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUBASH",
        "first_name": "CHARLES",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2013-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052918",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA-052918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunmore, PA

Sources for this page

Verify at the official NPI Registry.