Active NPI
Tanner Rae Mazur, PA-C
- Physician Assistant
- Wilkes Barre, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA060718
- Practice address
- 1175 E Mountain Blvd
Wilkes Barre, PA 18702-7906 - Phone
- (570) 808-1095
- Fax
- (570) 808-7878
- NPI assigned
- Aug 14, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | MA060718 | PA | |
| Physician Assistant | 363A00000X | MA060718 | PA | Primary |
Addresses
Primary practice location
1175 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144
Other practice location 1
648 N Main St
Taylor, PA 18517-1112
Phone (570) 348-1101
Other practice location 2
648 N Main St
Taylor, PA 18517-1112
Phone (570) 348-1101
Other practice location 3
3 W Olive St Ste 118
Scranton, PA 18508
Phone (570) 961-3823
Other practice location 4
3 W Olive St
Scranton, PA 18508-2572
Phone (570) 961-3822
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, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144
1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone (570) 826-7300
114 LT Michael Cleary Dr
Dallas, PA 18612-1649
Phone (570) 255-1178
1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone (570) 808-5135
1175 E Mountain Blvd
Suite 150723
Wilkes Barre, PA 18702-7906
Phone (570) 808-1093
35 S Mountain Blvd
Mountain Top, PA 18707-1122
Phone (570) 474-5847
42 N Main St
Pittston, PA 18640-1916
Phone (570) 654-0880
Hospital & facility affiliations
- Geisinger Wyoming Valley Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA060718 | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Medical Oncology Lock Haven | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Past | Accepting new patients |
Locations
114 Lt Michael Cleary Dr
Dallas, PA 18612
Phone (570) 255-1178
100 N Academy Ave
Danville, PA 17822
560 Pierce St
Kingston, PA 18704
Phone (570) 283-2161
128 E Main St
Nanticoke, PA 18634
Phone (570) 258-1304
42 N Main St
Pittston, PA 18640
Phone (570) 602-5610
1201 Oak St
Pittston, PA 18640
Phone (570) 808-9800
300 Lackawanna Ave
Scranton, PA 18503
Phone (570) 342-7864
3 W Olive St
Scranton, PA 18508
Phone (570) 207-4054
3 W Olive St
Ste 118
Scranton, PA 18508
Phone (570) 961-3823
1020 Northern Blvd
South Abington Township, PA 18411
Phone (570) 587-2290
631 Northern Blvd
South Abington Township, PA 18411
Phone (570) 340-6920
10 Trieble Dr
Tunkhannock, PA 18657
Phone (570) 836-2273
Interoperability endpoints
- tenglehart192071@direct.geisinger.edu
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.
-
- Family Medicine Physician
- Danville, PA
- NPI 1366493868
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
-
- Medical Oncology Physician
- Lock Haven, PA
- NPI 1891197885
-
- Hospitalist Physician
- Wilkes Barre, PA
- NPI 1588614358
Hospital & facility affiliations 20
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Diagnostic Radiology Physician
- Pittston, PA
- NPI 1104292960
Hospital
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1174822068
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1275620585
-
- General Acute Care Hospital
- Pittston, PA
- NPI 1316692585
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664236800000",
"number": "1124674270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N ACADEMY AVE",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178224903",
"telephone_number": "570-271-6144",
"fax_number": "570-271-6578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 E MOUNTAIN BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187027906",
"telephone_number": "570-808-1095",
"fax_number": "570-808-7878"
}
],
"practiceLocations": [
{
"address_1": "648 N Main St",
"address_purpose": "LOCATION",
"city": "Taylor",
"state": "PA",
"postal_code": "185171112",
"country_code": "US",
"telephone_number": "570-348-1101",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "648 N Main St",
"address_purpose": "LOCATION",
"city": "Taylor",
"state": "PA",
"postal_code": "185171112",
"country_code": "US",
"telephone_number": "570-348-1101",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3 W Olive St Ste 118",
"address_purpose": "LOCATION",
"city": "Scranton",
"state": "PA",
"postal_code": "18508",
"country_code": "US",
"telephone_number": "570-961-3823",
"fax_number": "570-207-5988",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3 W Olive St",
"address_purpose": "LOCATION",
"city": "Scranton",
"state": "PA",
"postal_code": "185082572",
"country_code": "US",
"telephone_number": "570-961-3822",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAZUR",
"first_name": "TANNER",
"middle_name": "RAE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-14",
"last_updated": "2022-09-27",
"certification_date": "2022-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA060718",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA060718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; 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.