Individual provider Active NPI

Michael Joseph Hudock, MD

  • Ophthalmology Physician
  • Sayre, PA
National Provider Identifier
1275501157
Registry record updated Mar 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD027583E Issued in PA
Practice address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone
(570) 888-5858
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 162180-1 NY
Ophthalmology Physician 207W00000X MD027583E PA Primary

Addresses

Primary practice location

1 Guthrie SQ
Sayre, PA 18840-1625

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Other identifiers 3

IdentifierTypeStateIssuer
CC9269OtherPARR MEDICARE GROUP
180040318OtherPARR MEDICARE PIN
GU039847OtherPAMEDICARE GROUP

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mhudock4522@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101103001160 NY Practitioner - Ophthalmology 0648464636 Reassigns benefits to 1 organization
I20101206000318 PA Practitioner - Ophthalmology 0648464636 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
162180-1NYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guthrie Medical Group, LTD. Current Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Dec 1, 2000 Accepting new patients
Guthrie Medical Group, P.C. Ophthalmology CurrentSince Jul 18, 1988 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jul 18, 1988 Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients
Guthrie Clinic LTD Past Accepting new patients
Guthrie Medical Group, P.C. Past Accepting new patients

Locations

130 Center Way
Corning, NY 14830
Phone (607) 936-9971

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

Interoperability endpoints

  • Direct secure messaging: mhudock4522@direct-guthrie.org

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615075200000",
    "number": "1275501157",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDOCK",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "162180-1",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD027583E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CC9269",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "180040318",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GU039847",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mhudock4522@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1 Guthrie Sq",
            "city": "Sayre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "188401625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sayre, PA

Sources for this page

Verify at the official NPI Registry.