NPIMap

Individual provider Active NPI

Charles J Kovalchick, DO

  • Family Medicine Physician
  • Lake Ariel, PA
National Provider Identifier
1144215682
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009495L Issued in PA
Practice address
543 Easton Tpke
Lake Ariel, PA 18436-4718
Phone
(570) 689-9965
Fax
(570) 689-0387
NPI assigned
Sep 12, 2005
Last updated
Jul 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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 OS009495L PA Primary

Addresses

Primary practice location

543 Easton Tpke
Lake Ariel, PA 18436-4718

Mailing address

300 W King St
Littlestown, PA 17340-1446
Phone (717) 359-9214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060502000238 PA Practitioner - Family Practice 3971513284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

273 Grandview Ave
Honesdale, PA 18431-1163
Phone (570) 390-4545

412 Como Rd
Lake Como, PA 18437-1020
Phone (570) 798-2828

543 Easton Tpke
Lake Ariel, PA 18436-4718
Phone (570) 689-9965

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS009495LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne Memorial Community Health Centers Family Medicine CurrentSince Feb 12, 2018 Accepting new patients
Wayne Memorial Community Health Centers CurrentSince Feb 12, 2018 Accepting new patients
Wayne Memorial Community Health Centers Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

601 Park St
Honesdale, PA 18431
Phone (570) 253-8100

543 Easton Tpke
Ste 105
Lake Ariel, PA 18436
Phone (570) 689-4670

412 Como Rd
Lake Como, PA 18437
Phone (570) 775-7100

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 37

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1144215682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W KING ST",
            "city": "LITTLESTOWN",
            "state": "PA",
            "postal_code": "173401446",
            "telephone_number": "717-359-9214",
            "fax_number": "717-359-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 EASTON TPKE",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184364718",
            "telephone_number": "570-689-9965",
            "fax_number": "570-689-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVALCHICK",
        "first_name": "CHARLES",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009495L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Ariel, PA

Sources for this page

Verify at the official NPI Registry.