Active NPI
Andrea Leigh Wickus, PAC
- Physician Assistant
- Leesport, PA
National Provider Identifier
1104881879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- OA005642
- Practice address
- 5 S Centre Avenue
Leesport, PA 19533 - Phone
- (610) 926-5707
- Fax
- (610) 926-8352
- NPI assigned
- Apr 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OA005642 | PA | Primary |
Addresses
Primary practice location
5 S Centre Avenue
Leesport, PA 19533
Mailing address
5 S Centre Ave
Leesport, PA 19533-8653
Phone (610) 926-5707
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50053971 | Other | PA | CAPITAL BLUE CROSS |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1120 Cocoa Ave
Hershey, PA 17033-1712
Phone (717) 533-4141
5 S Centre Ave
Suite A3 Pshmg Schuylkill Valley
Leesport, PA 19533-8661
Phone (610) 926-5707
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.85 of 100
- Quality
- 65.84
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penn State Health Medical Group, LLC | Current | Accepting new patients | |
| Penn State Health Medical Group, LLC | Current | Accepting new patients | |
| Penn State Health Medical Group, LLC | Past | Accepting new patients |
Locations
1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141
5 S Centre Ave
Ste A3
Leesport, PA 19533
Phone (610) 921-6570
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.
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- Harrisburg, PA
- NPI 1861988644
-
- Diagnostic Radiology Physician
- Harrisburg, PA
- NPI 1457824013
-
- Cardiovascular Disease Physician
- Camp Hill, PA
- NPI 1134874779
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Orwigsburg, PA
- NPI 1265096069
-
- General Acute Care Hospital
- West Reading, PA
- NPI 1467007112
-
- General Acute Care Hospital
- West Reading, PA
- NPI 1669530069
-
- General Acute Care Hospital
- Reading, PA
- NPI 1699734665
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674172800000",
"number": "1104881879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 S CENTRE AVE",
"city": "LEESPORT",
"state": "PA",
"postal_code": "195338653",
"telephone_number": "610-926-5707",
"fax_number": "610-926-8352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 S CENTRE AVENUE",
"city": "LEESPORT",
"state": "PA",
"postal_code": "19533",
"telephone_number": "610-926-5707",
"fax_number": "610-926-8352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKUS",
"first_name": "ANDREA",
"middle_name": "LEIGH",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-18",
"last_updated": "2023-01-20",
"certification_date": "2023-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "OA005642",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50053971",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.