Courtney L. Fedorek, PA-C
Individual provider Active NPI Medical Physician Assistant · Hickory, PA
NPI 1063769008 · NPPES record last updated Jul 6, 2023
Key facts
- NPI
- 1063769008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- MA055594 (PA)
- Practice address
- 4151 Henderson Rd
Hickory, PA 15340-1439 - Phone
- (724) 356-2273
- Fax
- (724) 356-2585
- NPI assigned
- Aug 9, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Preferred Primary Care Physicians, Inc.
Practice addresses (Care Compare)
2375 Greentree Rd
Carnegie, PA 15106-4203
Phone (412) 276-1560
4151 Henderson Rd
Hickory, PA 15340-1439
Phone (724) 356-2273
701 Technology Dr
Suite 150
Canonsburg, PA 15317-9531
Phone (412) 531-2902
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130703000637 | PA | Practitioner - Physician Assistant | 8921248410 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA055594 | PA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preferred Primary Care Physicians, Inc. | Current |
Accepting new patients | |
| Preferred Primary Care Physicians, Inc. | Current |
Accepting new patients | |
| Preferred Primary Care Physicians, Inc. | Past | Accepting new patients |
Locations
1423 Burgettstown Plz
Burgettstown, PA 15021
Phone (724) 579-3771
701 Technology Dr
Ste 150
Canonsburg, PA 15317
Phone (412) 531-2902
2375 Greentree Rd
Carnegie, PA 15106
Phone (412) 276-1560
4151 Henderson Rd
Hickory, PA 15340
Phone (724) 356-2273
1910 Cochran Rd
Ste 490
Pittsburgh, PA 15220
Interoperability endpoints
- courtneyfedorekpac@preferred.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA055594 | PA | Yes |
Addresses
Primary practice location
4151 Henderson Rd
Hickory, PA 15340-1439
Mailing address
701 Technology Dr Ste 150
Canonsburg, PA 15317-9531
Phone (412) 531-2902
Other practice location 1
1302 7th Ave
Beaver Falls, PA 15010-4217
Phone (724) 843-4400
Other practice location 2
1423 Burgettstown Plz
Burgettstown, PA 15021-1187
Phone (724) 947-4770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0195236 | Medicaid | OH | |
| 1031109670001 | Medicaid | PA | |
| 288685RN0 | Other | PA | MEDICARE |
Other providers in Hickory, PA
- America'S Peace of Mind LLC
- Michael Falcione
- Genmed LLC
- Megan K Glasser
- Hickory Family Practice
- Dana Renee Kahrig
- Bruce K Maskarinec
All providers in Hickory, PA · Medical Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.