Lu-Anne Antisdel, PA
Individual provider Active NPI Physician Assistant · Owego, NY
NPI 1104461318 · NPPES record last updated Nov 12, 2019
Key facts
- NPI
- 1104461318
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 024397 (NY)
- Practice address
- 42 W Main St
Owego, NY 13827-1578 - Phone
- (607) 687-0350
- Fax
- (607) 687-0333
- NPI assigned
- Nov 12, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Guthrie Medical Group PC
Practice addresses (Care Compare)
1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858
One Guthrie SQ
Sayre, PA 18840-1625
One Guthrie Square
Sayre, PA 18840-1625
Hospital & facility affiliations
- Robert Packer Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, 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 |
|---|---|---|---|---|
| I20200221001680 | NY | Practitioner - Physician Assistant | 5496182230 | Reassigns benefits to 3 organizations |
| I20220225000013 | PA | Practitioner - Physician Assistant | 5496182230 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024397 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guthrie Medical Group, P.C. | Current |
Accepting new patients | |
| Guthrie Medical Group, P.C. | Current |
Accepting new patients | |
| Guthrie Medical Group, P.C. | Current | Accepting new patients | |
| United Health Services Hospitals, Inc. | Current |
Accepting new patients | |
| Guthrie Medical Group, P.C. | Current | Accepting new patients | |
| Guthrie Medical Group, P.C, | Current | Accepting new patients | |
| United Medical Associates PC | Current |
Accepting new patients | |
| Guthrie Medical Group, P.C. | Current |
Accepting new patients | |
| Guthrie Medical Group PC | Past | Accepting new patients |
Locations
33 Lewis Rd
Ste 2
Binghamton, NY 13905
33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156
130 Center Way
Corning, NY 14830
Phone (607) 936-9971
4057 West Rd
Cortland, NY 13045
Phone (607) 299-7116
720 Willow Ave
Ithaca, NY 14850
Phone (570) 887-3025
33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412
42 W Main St
Owego, NY 13827
Phone (607) 687-0350
1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106
132 Colonial Dr
Towanda, PA 18848
Phone (570) 265-6165
7 Water St
Wellsboro, PA 16901
Phone (570) 724-1010
110 Plaza Ln
Wellsboro, PA 16901
Phone (570) 724-4241
Interoperability endpoints
- lantisdel184165@direct-guthrie.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 024397 | NY | Yes |
Addresses
Primary practice location
42 W Main St
Owego, NY 13827-1578
Mailing address
33 Lewis Rd Ste 2
Binghamton, NY 13905-1040
Phone (607) 729-8156
Other providers in Owego, NY
- Kathryn Elizabeth Alliger
- Christopher Allis
- Arvin Lindo Aranda
- Timothy Atha
- Delos Christian Aumock
- Rachael Baker
- Julie Dawn Barnes
All providers in Owego, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2019. 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.