Individual provider Active NPI

Gary M Pryblick, DO

  • Family Medicine Physician
  • Allentown, PA
National Provider Identifier
1124083555
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS007965L Issued in PA
Practice address
3050 Hamilton Blvd
Suite 100
Allentown, PA 18103-3691
Phone
(610) 437-7181
Fax
(610) 435-0597
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS007965L PA Primary

Addresses

Primary practice location

3050 Hamilton Blvd
Suite 100
Allentown, PA 18103-3691

Mailing address

3050 Hamilton Blvd
Suite 100
Allentown, PA 18103-3691
Phone (484) 526-6048

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101110000531 PA Practitioner - Family Practice 3476748989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS007965LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Physician Group Inc Family Medicine CurrentSince Aug 1, 2003 Accepting new patients
St. Luke'S Physician Group, Inc. Family Medicine CurrentSince Aug 1, 2003 Accepting new patients
St. Luke'S Physician Group, Inc. Family Medicine Current Accepting new patients

Locations

3050 Hamilton Blvd
Ste 100
Allentown, PA 18103
Phone (484) 526-6048

1901 Hamilton St
Unit 2
Allentown, PA 18104
Phone (215) 437-7181

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1124083555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 HAMILTON BLVD",
            "address_2": "SUITE 100",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181033691",
            "telephone_number": "484-526-6048",
            "fax_number": "484-526-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 HAMILTON BLVD",
            "address_2": "SUITE 100",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181033691",
            "telephone_number": "610-437-7181",
            "fax_number": "610-435-0597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYBLICK",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS007965L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.