NPIMap

Individual provider Active NPI

Bogdan Protyniak, MD, FACS, FASCRS

  • Colon & Rectal Surgery Physician
  • Wilkes-Barre, PA
National Provider Identifier
1154632388
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
MD457834 Issued in PA
Practice address
1000 East Mountain Blvd
MC: 37-62
Wilkes-Barre, PA 18711
Phone
(570) 808-2340
Fax
(570) 808-7904
NPI assigned
Jun 22, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD457834 PA
Colon & Rectal Surgery Physician 208C00000X MD457834 PA Primary

Addresses

Primary practice location

1000 East Mountain Blvd
MC: 37-62
Wilkes-Barre, PA 18711

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bprotyniak137122@direct.geisinger.edu Direct

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
I20160913002282 PA Practitioner - General Surgery 1850607714 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

401 N 17TH St
105 LV Specialty Care Physicians Practice
Allentown, PA 18104-5049
Phone (610) 969-4470

Hospital & facility affiliations

  • Lehigh Valley Home Care Home health agency, Allentown, PA, CCN 397023
  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133
  • St Lukes Hospital Hospital, Bethlehem, PA, CCN 390049

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy129
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD457834PAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Sep 1, 2016 Accepting new patients
Lehigh Valley Physician Group CurrentSince May 12, 2024 Accepting new patients
Family Care Centers Inc CurrentSince Mar 1, 2023 Accepting new patients
Family Care Centers Inc. Surgery CurrentSince Mar 1, 2023 Accepting new patients
Lehigh Valley Physician Group Surgery Current Accepting new patients
Geisinger Clinic CurrentSince Sep 1, 2016 Accepting new patients
Lehigh Valley Physician Group CurrentSince May 12, 2024 Accepting new patients
Pulmonary Associates PC Past Accepting new patients
Lehigh Valley Hospital Pocono Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

401 N 17th St
Ste 105
Allentown, PA 18104
Phone (610) 432-2013

100 N Academy Ave
Danville, PA 17822

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

175 E Brown St
East Stroudsburg, PA 18301
Phone (570) 421-3401

500 Plaza Ct
Ste A
East Stroudsburg, PA 18301
Phone (570) 424-9970

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

281 N 12th St
Ste B
Lehighton, PA 18235
Phone (610) 377-7793

320 W Pumping Station Rd
Quakertown, PA 18951
Phone (215) 529-4240

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

1000 E Mountain Blvd
#3762
Wilkes Barre, PA 18711
Phone (570) 808-2340

Organizations & group practices 11

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1154632388",
    "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": "1000 EAST MOUNTAIN BLVD",
            "address_2": "MC: 37-62",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "18711",
            "telephone_number": "570-808-2340",
            "fax_number": "570-808-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROTYNIAK",
        "first_name": "BOGDAN",
        "name_prefix": "Dr.",
        "credential": "MD, FACS, FASCRS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD457834",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "PA",
            "license": "MD457834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bprotyniak137122@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1000 East Mountain Blvd",
            "address_2": "MC: 37-62",
            "city": "Wilkes-Barre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "18711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilkes-Barre, PA

Sources for this page

Verify at the official NPI Registry.