NPIMap

Organization Active NPI

Geisinger Wyoming Valley Medical Center

  • Clinic/Center
  • Wilkes Barre, PA
National Provider Identifier
1205197894
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice address
1175 East Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone
(570) 808-1093
Fax
(570) 808-7878
NPI assigned
May 31, 2012
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Cindy Mull
Title
Director
Phone
(570) 271-6144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1175 East Mountain Blvd
Wilkes Barre, PA 18702-7906

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6211

Other identifiers 2

IdentifierTypeStateIssuer
390270OtherMEDICARE
7593410001OtherPAMEDICARE DME NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040901000618 PA Part A Provider - Hospital 5092780023 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilkes Barre, PA; Wilkes-Barre, PA; Wilkes -Barre, PA; Dallas, PA; Dickson City, PA; Forty Fort, PA; Mountain Top, PA; Mountaintop, PA…
O20170502000369 PA DME Supplier - Orthotic PersonnelDME Supplier - Physician AssistantDME Supplier - Physician - Unknown Physician SpecialtyDME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - PodiatryDME Supplier - Nurse PractitionerDME Supplier - Sports Medicine 5092780023 Practice locations: Wilkes Barre, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205197894. Details of each certification follow.

Hospital certification: CCN 390270

Legal name
GEISINGER WYOMING VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Apr 20, 1981
Last certification
Sep 4, 2025
Beds
356 (317 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 2, 1976 in PA
Enrollment address
1000 East Mountain Drive
GWV Op Surgery
Wilkes Barre, PA 18711-0027
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

Care Compare: Hospital

Medicare Care Compare
Listed as
Geisinger Wyoming Valley Medical CenterCCN 390270 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Geisinger Wyoming Valley Medical Ce1175 E Mountain Blvd, Wilkes Barre, PA 18702-7906(570) 808-4779 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Does not accept assignmentParticipating since Feb 24, 2017

National Provider Directory

National Provider Directory
Tax ID family
GMG Wilkes Barre Neurol24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terry Gilliland Individual Corporate Officer Mar 1, 2025
Daniel J Gaydon Individual Corporate OfficerAssociate Vice President, Finance Jan 1, 2026
W-2 Managing Employee Jan 1, 2026
William Schultz Individual Corporate OfficerVice President & Cfo Jan 1, 2026
W-2 Managing Employee Jan 1, 2026
Jeffrey a Jacobson Individual Corporate Officer Jan 1, 2019
Chris Holcombe Individual Corporate Officer Jan 1, 2017
Benjamin K Chu Individual Corporate Director Jan 1, 2020
Virginia McGregor Individual Corporate Officer Jan 1, 2017
Jason Mitchell Individual Corporate Officer Jan 1, 2026
Megan Brosious Individual Corporate Officer Mar 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1,567

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,567

NPI Registry JSON

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1205197894",
    "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": "570-271-6211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 EAST MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027906",
            "telephone_number": "570-808-1093",
            "fax_number": "570-808-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER WYOMING VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "MULL",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "570-271-6144"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "390270",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME NUMBER",
            "identifier": "7593410001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.