Active NPI
Lanny C Pelliccia, DPM
- Podiatrist
- Kingston, PA
National Provider Identifier
1114922648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- SC-003688-L
- Practice address
- 270 Pierce St
Ste 301
Kingston, PA 18704-5141 - Phone
- (570) 283-3668
- Fax
- (570) 283-0309
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | SC-003688-L | PA | Primary |
Addresses
Primary practice location
270 Pierce St
Ste 301
Kingston, PA 18704-5141
Mailing address
270 Pierce St
Ste 301
Kingston, PA 18704-5141
Phone (570) 283-3668
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| U27800 | Other | HEALTH ASSURANCE | |
| 05152 | Other | EMPIRE BC/BS | |
| 232635090 001 | Other | TRICARE / CHAMPUS | |
| 4532974 | Other | AETNE / PPO | |
| G09847 | Other | AMERIHEALTH | |
| 075903 | Other | PA | FIRST PRIORITY HEALTH |
| 611664 | Other | TRIGON / MEDIGAP | |
| PE709847 | Other | PA | BLUE CROSS / BLUE SHIELD |
| 001285747/0002 | Medicaid | PA | |
| 1502456 | Other | UNITED MINE WORKERS | |
| 26464 | Other | PA | GEISINGER HEALTH PLAN |
| P3179662 | Other | OXFORD | |
| 150228 | Other | GATEWAY | |
| 0528845 | Other | AETNA / HMO | |
| 76219 | Other | MEDPLUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC-003688-L | PA | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lanny C. Pelliccia DPM | Podiatrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Podiatrist
- Kingston, PA
- NPI 1306019856
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196899200000",
"number": "1114922648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 PIERCE ST",
"address_2": "STE 301",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187045141",
"telephone_number": "570-283-3668",
"fax_number": "570-283-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 PIERCE ST",
"address_2": "STE 301",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187045141",
"telephone_number": "570-283-3668",
"fax_number": "570-283-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLICCIA",
"first_name": "LANNY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2007-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "PA",
"license": "SC-003688-L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ASSURANCE",
"identifier": "U27800",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC/BS",
"identifier": "05152",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE / CHAMPUS",
"identifier": "232635090 001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNE / PPO",
"identifier": "4532974",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH",
"identifier": "G09847",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY HEALTH",
"identifier": "075903",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIGON / MEDIGAP",
"identifier": "611664",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS / BLUE SHIELD",
"identifier": "PE709847",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001285747/0002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED MINE WORKERS",
"identifier": "1502456",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER HEALTH PLAN",
"identifier": "26464",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3179662",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "150228",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA / HMO",
"identifier": "0528845",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDPLUS",
"identifier": "76219",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.