Individual provider Active NPI

Theodore Brian Bakowicz, PA-C

  • Physician Assistant
  • Monroeville, PA
National Provider Identifier
1194799072
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA003437L Issued in PA
Practice address
2580 Haymaker Rd Ste 304
Monroeville, PA 15146-3500
Phone
(412) 858-3070
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA003437L PA Primary

Addresses

Primary practice location

2580 Haymaker Rd Ste 304
Monroeville, PA 15146-3500

Mailing address

2580 Haymaker Rd Ste 304
Monroeville, PA 15146-3500
Phone (412) 858-3070

Other identifiers 1

IdentifierTypeStateIssuer
13639468OtherCAQH

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040915001230 PA Practitioner - Physician Assistant 6305813544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allegheny ClinicGroup PAC ID 5395649586, 2,313 clinicians

Practice addresses (Care Compare)

2566 Haymaker Rd
Suite 107
Monroeville, PA 15146-3553
Phone (412) 858-4150

2570 Haymaker Rd
Monroeville, PA 15146-3513
Phone (412) 359-6656

320 E N Ave
Pittsburgh, PA 15212-4756

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince Jan 18, 2010 Accepting new patients
Allegheny Clinic CurrentSince Aug 19, 2023 Accepting new patients
Allegheny Clinic CurrentSince Aug 19, 2023 Accepting new patients
Excela Health Physician Practices, Inc CurrentSince Jan 18, 2010 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Allegheny Clinic Past Accepting new patients

Locations

530 South St
Ste 380
Greensburg, PA 15601
Phone (724) 261-5556

540 South St
Ste 306
Greensburg, PA 15601
Phone (724) 832-3130

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

2580 Haymaker Rd
Ste 304
Monroeville, PA 15146
Phone (412) 578-4341

2566 Haymaker Rd
Ste 304
Monroeville, PA 15146
Phone (412) 457-0040

320 E North Ave
Ste 261
Pittsburgh, PA 15212
Phone (412) 359-3901

Interoperability endpoints

  • Direct secure messaging: tbakowicz723448@direct.ahn.org

Organizations & group practices 8

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1194799072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 HAYMAKER RD STE 304",
            "city": "MONROEVILLE",
            "state": "PA",
            "postal_code": "151463500",
            "telephone_number": "412-858-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2580 HAYMAKER RD STE 304",
            "city": "MONROEVILLE",
            "state": "PA",
            "postal_code": "151463500",
            "telephone_number": "412-858-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKOWICZ",
        "first_name": "THEODORE",
        "middle_name": "BRIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA003437L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13639468",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroeville, PA

Sources for this page

Verify at the official NPI Registry.