NPIMap

Individual provider Active NPI

Kelly Ryan Machuca, MD

  • Sports Medicine (Family Medicine) Physician
  • Williamsport, PA
National Provider Identifier
1255915930
Registry record updated Apr 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD489557 Issued in PA
Practice address
700 High St
Williamsport, PA 17701-3100
Phone
(570) 321-2620
NPI assigned
May 10, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X MD489557 PA Primary

Addresses

Primary practice location

700 High St
Williamsport, PA 17701-3100

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelly.r.machuca@upmcdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250819000217 PA Practitioner - Family Practice 2668874223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, shared by 32 NPIs, 611 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1705 Warren Ave
103 Susquehanna Health Sports Medicine
Williamsport, PA 17701-2647
Phone (570) 321-2020

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

700 High St
Williamsport, PA 17701-3100
Phone (570) 321-2619

Hospital & facility affiliations

  • Upmc Williamsport Hospital, Williamsport, PA, CCN 390045
  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006
  • Upmc Susquehanna Williamsport Inpatient rehabilitation facility, Williamsport, PA, CCN 39T045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD489557PAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Dec 1, 2025 Accepting new patients
Susquehanna Physician Services Current Accepting new patients
Susquehanna Physician Services CurrentSince Aug 1, 2025 Accepting new patients
Susquehanna Physician Services CurrentSince Aug 1, 2025 Accepting new patients
Upmc Williamsport Past Accepting new patients

Locations

24 Cree Dr
Lock Haven, PA 17745
Phone (570) 893-5000

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

1201 Grampian Blvd
Ste 2F
Williamsport, PA 17701
Phone (570) 320-7598

700 High St
#P
Williamsport, PA 17701
Phone (570) 321-2619

1705 Warren Ave
Ste 101103
Williamsport, PA 17701

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

740 High St
Ste 4001
Williamsport, PA 17701
Phone (570) 321-2345

Organizations & group practices 5

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 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1255915930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HIGH ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013100",
            "telephone_number": "570-321-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACHUCA",
        "first_name": "KELLY",
        "middle_name": "RYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-10",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "MD489557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.r.machuca@upmcdirect.com",
            "affiliation": "N",
            "endpointDescription": "secure UPMC direct address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "600 Grant St Fl 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.