Individual provider Active NPI

Janelle Mackenzie Kothe, PA-C

  • Physician Assistant
  • Lancaster, PA
National Provider Identifier
1104598689
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA063178 Issued in PA
Practice address
2104 Harrisburg Pike Ste 200
Lancaster, PA 17601-2644
Phone
(717) 544-3626
Fax
(717) 544-3628
NPI assigned
Oct 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA063178 PA Primary

Addresses

Primary practice location

2104 Harrisburg Pike Ste 200
Lancaster, PA 17601-2644

Mailing address

2104 Harrisburg Pike Ste 200
Lancaster, PA 17601-2644
Phone (717) 544-3626

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
I20220221000436 PA Practitioner - Physician Assistant 3072907856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lancaster General Medical GroupGroup PAC ID 0941103683, 590 clinicians

Practice addresses (Care Compare)

554 N Duke St
LGHP Penn Med Plastic and Cosmetic Surgery
Lancaster, PA 17602-2250
Phone (717) 291-5863

555 N Duke St
Lancaster, PA 17602-2250

555 N Duke St 1St Floor
LGHP Penn Medicine Behavioral Health
Lancaster, PA 17602-2250
Phone (717) 560-3782

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA063178PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Apr 4, 2022 Accepting new patients
Lancaster General Medical Group CurrentSince Apr 4, 2022 Accepting new patients
Lancaster General Medical Group Past Accepting new patients

Locations

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

554 N Duke St
Lancaster, PA 17602
Phone (717) 291-5863

2104 Harrisburg Pike
Ste 200
Lancaster, PA 17601
Phone (717) 290-3626

Organizations & group practices 4

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 3

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": "1633132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1104598689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 HARRISBURG PIKE STE 200",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176012644",
            "telephone_number": "717-544-3626",
            "fax_number": "717-544-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 HARRISBURG PIKE STE 200",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176012644",
            "telephone_number": "717-544-3626",
            "fax_number": "717-544-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHE",
        "first_name": "JANELLE",
        "middle_name": "MACKENZIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-02",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA063178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.