NPIMap

Organization Active NPI

Wilkes-Barre Clinic Company LLC

  • Surgery Physician
  • Wilkes Barre, PA
National Provider Identifier
1144533670
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
WILKES-BARRE CLINIC COMPANY LLC
Practice address
575 N River St
Wilkes Barre, PA 18702-2634
Phone
(570) 552-1300
Fax
(570) 552-1498
NPI assigned
Jul 26, 2010
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Senior Director Provider Enrollment
Phone
(877) 892-9815

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X PA
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Surgical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086X0206X PA

Addresses

Primary practice location

575 N River St
Wilkes Barre, PA 18702-2634

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7000

Other practice location 1

468 Northampton St
Ste 9
Kingston, PA 18704-4566
Phone (570) 552-4720

Other identifiers 1

IdentifierTypeStateIssuer
102514239MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101108000160 PA Part B Supplier - Clinic/Group Practice 1557556313 Receives reassigned benefits from 7 practitioners
Practice locations: Wilkes Barre, PA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

600 Maple Ave
#2
Honesdale, PA 18431
Phone (570) 558-3540

746 Jefferson Ave
Ste 101
Scranton, PA 18510
Phone (570) 558-3540

4000 Meridian Blvd
Franklin, TN 37067
Phone (615) 465-7626

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1144533670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7000",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187022634",
            "telephone_number": "570-552-1300",
            "fax_number": "570-552-1498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "468 Northampton St",
            "address_2": "Ste 9",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "PA",
            "postal_code": "187044566",
            "country_code": "US",
            "telephone_number": "570-552-4720",
            "fax_number": "570-552-4725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILKES-BARRE CLINIC COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-26",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9815"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102514239",
            "state": "PA"
        }
    ],
    "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 Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.