Active NPI
Thomas James Iacovoni, PA-C
- Medical Physician Assistant
- Danville, PA
National Provider Identifier
1225262215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA053730
- Practice address
- 603 E Market St
Suite 200 - Cmsu
Danville, PA 17821-2161 - Phone
- (570) 275-4962
- Fax
- (570) 275-3098
- NPI assigned
- May 6, 2009
- Last updated
- Aug 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA053730 | PA | Primary |
Addresses
Primary practice location
603 E Market St
Suite 200 - Cmsu
Danville, PA 17821-2161
Mailing address
603 E Market St
Suite 200 - Cmsu
Danville, PA 17821-2161
Phone (570) 275-4962
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA053730 | PA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innerclarity LLC | Current | Accepting new patients | |
| Cmsu MH/Mr and D&a Program | Past | Accepting new patients | |
| Cmsu Behavioral Health and Developmental Services | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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-
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470873600000",
"number": "1225262215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 E MARKET ST",
"address_2": "SUITE 200 - CMSU",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178212161",
"telephone_number": "570-275-4962",
"fax_number": "570-275-3098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 E MARKET ST",
"address_2": "SUITE 200 - CMSU",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178212161",
"telephone_number": "570-275-4962",
"fax_number": "570-275-3098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IACOVONI",
"first_name": "THOMAS",
"middle_name": "JAMES",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-06",
"last_updated": "2016-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA053730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.