NPIMap

Individual provider Active NPI

Nicholas Vincent Iaccarino

  • Family Medicine Physician
  • Pottsville, PA
National Provider Identifier
1285160291
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS021016 Issued in PA
Practice address
529 Terry Reiley Way
Pottsville, PA 17901-1774
Phone
(570) 624-4444
Fax
(570) 624-4445
NPI assigned
May 11, 2017
Last updated
Oct 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS021016 PA Primary
Family Medicine Physician 207Q00000X OT017881 PA

Addresses

Primary practice location

529 Terry Reiley Way
Pottsville, PA 17901-1774

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
OT017881OtherPAPENNSYLVANIA LICENSE

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
I20210818003870 PA Practitioner - Family Practice 8325316060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

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

529 Terry Reiley Way
Pottsville, PA 17901-1774
Phone (570) 622-9508

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS021016PAMDFamily Medicine Physician
OT017881PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Family Medicine Current Accepting new patients
Geisinger Clinic CurrentSince Sep 20, 2021 Accepting new patients
Geisinger Clinic Family Medicine CurrentSince Sep 20, 2021 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

701 W Oak St
Frackville, PA 17931
Phone (570) 874-4100

529 Terry Reiley Way
Pottsville, PA 17901
Phone (570) 624-4120

Interoperability endpoints

  • Direct secure messaging: niaccarino466946@direct.geisinger.edu

Organizations & group practices 4

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1285160291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 TERRY REILEY WAY",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179011774",
            "telephone_number": "570-624-4444",
            "fax_number": "570-624-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACCARINO",
        "first_name": "NICHOLAS",
        "middle_name": "VINCENT",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS021016",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT017881",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA LICENSE",
            "identifier": "OT017881",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

Verify at the official NPI Registry.