Internal Medicine of Berwick PC Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD067594L Issued in PA

Legal business name

INTERNAL MEDICINE OF BERWICK PC INC

Practice address

751 E 16TH St
Suite300
Berwick, PA 18603-2321

Phone

(570) 752-5056

NPI assigned

Jun 11, 2006

Last updated

Aug 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Pavel Pribula, M.D.NPI 1043210628

Title

Owner

Phone

(570) 752-5056

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pavel Pribula, M.D.

  • Internal Medicine Physician
  • Berwick, PA
  • NPI 1043210628
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376265600000",
    "number": "1265474670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 E 16TH ST",
            "address_2": "SUITE300",
            "city": "BERWICK",
            "state": "PA",
            "postal_code": "186032321",
            "telephone_number": "570-752-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 E 16TH ST",
            "address_2": "SUITE300",
            "city": "BERWICK",
            "state": "PA",
            "postal_code": "186032321",
            "telephone_number": "570-752-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE OF BERWICK PC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2013-08-12",
        "status": "A",
        "authorized_official_last_name": "PRIBULA",
        "authorized_official_first_name": "PAVEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-752-5056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD067594L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "010093500",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1348169",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1533376",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075190570002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "221084",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02305400",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherri Ann Hoffman, MPH, RD, LDN
• Marvin Scott Hurley, D.O.
• Husak Holdings JTL, Inc (The Medicine Shoppe)
• Incare LLC
• Independence Corporation (Eyeland Optical)
• Invicta Med Transports LLC
• Kelly Anne Jayne, PA-C
• Tiffany Lynn Jensen, MHA, MBA
• Jean Dorothy Johnson, D.D.S.
• Roslon Johnson, CRNP

• Internal Medicine Physician in Berwick, PA
• Providers in Berwick, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.