NPIMap

Individual provider Active NPI

Michael Dopko, CRNA

  • Certified Registered Nurse Anesthetist
  • Wilkes Barre, PA
National Provider Identifier
1083684054
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
048962 Issued in PA
Practice address
25 Church St
Wilkes Barre, PA 18702-3507
Phone
(570) 826-3334
Fax
(570) 830-8887
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 048962 PA Primary

Addresses

Primary practice location

25 Church St
Wilkes Barre, PA 18702-3507

Mailing address

25 Church St
Wilkes Barre, PA 18702-3507
Phone (570) 826-3334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040601001156 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577545920 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone (570) 826-7300

1201 Oak St
Pittston, PA 18640-3798
Phone (570) 808-9800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
048962PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jan 1, 2008 Accepting new patients
Geisinger Clinic CurrentSince Jan 1, 2008 Accepting new patients
Gulfstream Anesthesia Consultants PA Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2010 Accepting new patients
Anesthesia Specialists of Bethlehem, PC Nurse Anesthetist, Certified Registered PastSince Oct 21, 2025 Accepting new patients
Fsljc, LLC. PastSince Apr 8, 2017 Accepting new patients

Locations

701 E 16th St
Berwick, PA 18603
Phone (570) 754-5000

100 N Academy Ave
Danville, PA 17822

275 Guthrie Dr
Troy, PA 16947
Phone (570) 297-2121

25 Church St
Wilkes Barre, PA 18702
Phone (570) 340-5800

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

25 Church St
Wilkes Barre, PA 18765
Phone (570) 826-3100

Organizations & group practices 6

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1083684054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CHURCH ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023507",
            "telephone_number": "570-826-3334",
            "fax_number": "570-830-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CHURCH ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023507",
            "telephone_number": "570-826-3334",
            "fax_number": "570-830-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOPKO",
        "first_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "048962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.