NPIMap

Individual provider Active NPI

Elzbieta Ewa Jacek

  • Family Medicine Physician
  • Laurys Station, PA
National Provider Identifier
1265968796
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD471194 Issued in PA
Practice address
5649 Wynnewood Dr Ste 203
Laurys Station, PA 18059-1124
Phone
(610) 261-1123
Fax
(610) 262-1739
NPI assigned
May 3, 2017
Last updated
Sep 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 271782 MA
Family Medicine Physician 207Q00000X MD471194 PA Primary

Addresses

Primary practice location

5649 Wynnewood Dr Ste 203
Laurys Station, PA 18059-1124

Mailing address

2100 Mack Blvd
Allentown, PA 18103-5622
Phone (484) 884-0617

Other practice location 1

195 Canal St
Malden, MA 02148-6701
Phone (781) 338-0500

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
I20200909000531 PA Practitioner - Family Practice 4385911395 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

14351 Kutztown Rd
Fleetwood, PA 19522-9273
Phone (610) 944-8800

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Schuylkill Health System Medical Group, Inc. Family Medicine CurrentSince Dec 1, 2024 Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Sep 2, 2020 Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Sep 2, 2020 Accepting new patients
Family Care Centers Inc Family Medicine CurrentSince Dec 1, 2024 Accepting new patients
Lehigh Valley Physician Group Family Medicine Current Accepting new patients
Schuylkill Health System Medical Group, Inc. Family Medicine Current Accepting new patients
Family Care Centers Inc. Family Medicine Current Accepting new patients

Locations

2100 Mack Blvd
Allentown, PA 18103
Phone (484) 224-1892

2100 Mack Blvd
Fl 4
Allentown, PA 18103

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

14351 Kutztown Rd
Fleetwood, PA 19522
Phone (610) 944-8800

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

5649 Wynnewood Dr
Ste 203
Laurys Station, PA 18059
Phone (610) 261-1123

700 Schuylkill Manor Rd
Ste 3
Pottsville, PA 17901
Phone (570) 621-4440

Interoperability endpoints

  • Direct secure messaging: ejacek432502@direct2.lvhn.org

Organizations & group practices 8

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1265968796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "484-884-0617",
            "fax_number": "484-884-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5649 WYNNEWOOD DR STE 203",
            "city": "LAURYS STATION",
            "state": "PA",
            "postal_code": "180591124",
            "telephone_number": "610-261-1123",
            "fax_number": "610-262-1739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "195 Canal St",
            "address_purpose": "LOCATION",
            "city": "Malden",
            "state": "MA",
            "postal_code": "021486701",
            "country_code": "US",
            "telephone_number": "781-338-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACEK",
        "first_name": "ELZBIETA",
        "middle_name": "EWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-03",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "271782",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD471194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurys Station, PA

Sources for this page

Verify at the official NPI Registry.