NPIMap

Individual provider Active NPI

Mark Mitchell Malicki, MD

  • Family Medicine Physician
  • Johnstown, PA
National Provider Identifier
1083619209
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD069004L Issued in PA
Practice address
322 Warren St
Ste 300
Johnstown, PA 15905-3443
Phone
(814) 288-1418
Fax
(814) 288-1525
NPI assigned
Jun 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

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 MD069004L PA Primary

Addresses

Primary practice location

322 Warren St
Ste 300
Johnstown, PA 15905-3443

Mailing address

322 Warren St
Ste 300
Johnstown, PA 15905-3443
Phone (814) 288-1418

Other identifiers 1

IdentifierTypeStateIssuer
0017621130005MedicaidPA

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
I20100826000274 PA Practitioner - Family Practice 1658495767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richard M Kastelic MD and Assoc PCGroup PAC ID 8022094150, 6 clinicians
Vantage Physical Therapy and Rehabilitation IncGroup PAC ID 3072424886, 253 clinicians

Practice addresses (Care Compare)

322 Warren St
Suite 300
Johnstown, PA 15905-3443
Phone (814) 288-4498

336 Bloomfield St
Johnstown, PA 15904-3271
Phone (814) 269-2224

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD069004LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richard M Kastelic MD & Assoc PC Family Medicine CurrentSince Jul 6, 1999 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

322 Warren St
Ste 300
Johnstown, PA 15905
Phone (814) 288-4498

Interoperability endpoints

  • Direct secure messaging: drmalicki@bhmedical.medentdirect.com

Organizations & group practices 3

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 12

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

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276732800000",
    "number": "1083619209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 WARREN ST",
            "address_2": "STE 300",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053443",
            "telephone_number": "814-288-1418",
            "fax_number": "814-288-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 WARREN ST",
            "address_2": "STE 300",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053443",
            "telephone_number": "814-288-1418",
            "fax_number": "814-288-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALICKI",
        "first_name": "MARK",
        "middle_name": "MITCHELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2010-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD069004L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017621130005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.