NPIMap

Organization Active NPI

Orthopaedic Consultants of Wyoming Valley LLC

  • Orthopaedic Surgery Physician
  • Kingston, PA
National Provider Identifier
1114939451
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPAEDIC CONSULTANTS OF WYOMING VALLEY LLC
Practice address
390 Pierce St
Kingston, PA 18704-5532
Phone
(570) 288-3535
Fax
(570) 288-0804
NPI assigned
Aug 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michael C Raklewicz, MD
Title
Partner
Phone
(570) 288-3535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

390 Pierce St
Kingston, PA 18704-5532

Mailing address

PO Box 1463
Kingston, PA 18704-0463
Phone (570) 288-3535

Other identifiers 2

IdentifierTypeStateIssuer
0018536010001MedicaidPA
925341OtherPABLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114939451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1463",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187040463",
            "telephone_number": "570-288-3535",
            "fax_number": "570-288-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 PIERCE ST",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045532",
            "telephone_number": "570-288-3535",
            "fax_number": "570-288-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC CONSULTANTS OF WYOMING VALLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAKLEWICZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "570-288-3535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018536010001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "925341",
            "state": "PA"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.