Active NPI
Loella E. Clark Wickey, MD
- Family Medicine Physician
- Corning, NY
National Provider Identifier
1235105230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 173504-1
- Practice address
- 130 Center Way
Corning, NY 14830-2255 - Phone
- (607) 936-9971
- Fax
- (607) 936-2600
- NPI assigned
- Feb 28, 2006
- Last updated
- Nov 2, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 173504-1 | NY | Primary |
Addresses
Primary practice location
130 Center Way
Corning, NY 14830-2255
Mailing address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01060824 | Medicaid | NY | |
| 0011150680003 | Medicaid | PA | |
| CC8362 | Other | NY | RR MEDICARE GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 173504-1 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guthrie Medical Group, P.C. | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1235105230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 GUTHRIE SQ",
"city": "SAYRE",
"state": "PA",
"postal_code": "188401625",
"telephone_number": "570-888-5858",
"fax_number": "570-882-3007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 CENTER WAY",
"city": "CORNING",
"state": "NY",
"postal_code": "148302255",
"telephone_number": "607-936-9971",
"fax_number": "607-936-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKEY",
"first_name": "LOELLA",
"middle_name": "E. CLARK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-28",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "173504-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01060824",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011150680003",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CC8362",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corning, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.