Active NPI
Warren Dewitt, MD
- Family Medicine Physician
- Susquehanna, PA
National Provider Identifier
1245328145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD024723E
- Practice address
- 401 Broad Ave
Susquehanna, PA 18847-1611 - Phone
- (570) 853-3995
- Fax
- (570) 853-3728
- NPI assigned
- Oct 10, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD024723E | PA | Primary |
Addresses
Primary practice location
401 Broad Ave
Susquehanna, PA 18847-1611
Mailing address
401 Broad Ave
Susquehanna, PA 18847-1611
Phone (570) 853-3995
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00008041930008 | Medicaid | PA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090319000474 | PA | Practitioner - Family Practice | 2567405707 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Temple University School of Medicine, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Health Clinic, Inc.
Practice addresses (Care Compare)
401 Broad Ave
Susquehanna, PA 18847-1611
Phone (570) 853-3995
Hospital & facility affiliations
- Barnes-Kasson County Hospital
- Geisinger-Community Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Clinic Inc | Current | Accepting new patients |
Locations
401 Broad Ave
Susquehanna, PA 18847
Phone (570) 853-3995
Interoperability endpoints
- warren.de.witt.1@24136.direct.athenahealth.com
- https://api.platform.athenahealth.com/24136/brand/1/csg/1/fhir/r4
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Susquehanna Family Health Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (33.34%) Corporate Officer (33.34%) Operational/Managerial Control (33.34%) |
Sep 1, 2020 Sep 1, 2020 Sep 1, 2020 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Rural Health Clinic/Center
- Susquehanna, PA
- NPI 1972529543
5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control
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 and National Provider Directory roles.
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Endocrinology, Diabetes & Metabolism Physician
- Scranton, PA
- NPI 1306439856
Hospital
-
- Diagnostic Radiology Physician
- Scranton, PA
- NPI 1467850149
Hospital
-
- Radiology Clinic/Center
- Scranton, PA
- NPI 1548648272
Hospital
-
- Radiology Clinic/Center
- Scranton, PA
- NPI 1124405592
Hospital
-
- Physical Therapy Clinic/Center
- Scranton, PA
- NPI 1336526276
Hospital
-
- Sleep Disorder Diagnostic Clinic/Center
- Scranton, PA
- NPI 1417334350
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425945600000",
"number": "1245328145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 BROAD AVE",
"city": "SUSQUEHANNA",
"state": "PA",
"postal_code": "188471611",
"telephone_number": "570-853-3995",
"fax_number": "570-853-3728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 BROAD AVE",
"city": "SUSQUEHANNA",
"state": "PA",
"postal_code": "188471611",
"telephone_number": "570-853-3995",
"fax_number": "570-853-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWITT",
"first_name": "WARREN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2015-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD024723E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00008041930008",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Susquehanna, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.