Individual provider Active NPI

John A Consalvo, M.D.

  • Emergency Medicine Physician
  • Peckville, PA
National Provider Identifier
1184675274
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD025156E Issued in PA
Practice address
1400 Main St
Peckville, PA 18452-2009
Phone
(570) 489-7546
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD025156E PA Primary

Addresses

Primary practice location

1400 Main St
Peckville, PA 18452-2009

Mailing address

2000 Green Rd
Suite 300
Ann Arbor, MI 48105-1598
Phone (734) 995-3764

Other identifiers 3

IdentifierTypeStateIssuer
0009688010014MedicaidPA
0041657000OtherPAINDEPENDENCE BC
414646OtherPAHIGHMARK BS

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
I20080206000511 PA Practitioner - Emergency Medicine 7810070398 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Associates of Pennsylvania, PC Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Emergency Care Services of Pennsylvania, P.C. Emergency Medicine CurrentSince Aug 1, 2013 Accepting new patients
Emergency Care Services of Pennsylvania, P.C. Emergency Medicine Current Accepting new patients
Professional Emergency Care, PC Emergency Medicine Past Accepting new patients

Locations

300 Highland Ave
Hanover, PA 17331
Phone (717) 316-3711

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

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.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296086400000",
    "number": "1184675274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GREEN RD",
            "address_2": "SUITE 300",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051598",
            "telephone_number": "734-995-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST",
            "city": "PECKVILLE",
            "state": "PA",
            "postal_code": "184522009",
            "telephone_number": "570-489-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONSALVO",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2011-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD025156E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009688010014",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BC",
            "identifier": "0041657000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "414646",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peckville, PA

Sources for this page

Verify at the official NPI Registry.