NPIMap

Individual provider Active NPI

Pauline Hricisak Kostelac, DO

  • Family Medicine Physician
  • Mechanicsburg, PA
National Provider Identifier
1336177443
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS007429L Issued in PA
Practice address
555 Gettysburg Pike Ste C300
Mechanicsburg, PA 17055-5206
Phone
(717) 458-8840
Fax
(717) 795-4138
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS007429L PA Primary

Addresses

Primary practice location

555 Gettysburg Pike Ste C300
Mechanicsburg, PA 17055-5206

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other identifiers 1

IdentifierTypeStateIssuer
0070574900003MedicaidPA

Other names 1

  • Pauline Marie Hricisak Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address paulinekostelacdo@fpc.medentdirect.com Health Information Exchange (HIE) FAMILY PRACTICE CENTER, PC

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
I20100715000825 PA Practitioner - Family Practice 0840322566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Family Practice Center PCGroup PAC ID 0244124212, 351 clinicians

Practice addresses (Care Compare)

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

555 Gettysburg Pike
Suite C300
Mechanicsburg, PA 17055-5206
Phone (717) 458-8840

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC Family Medicine CurrentSince Jul 1, 2016 Accepting new patients
Family Practice Center, PC CurrentSince Jul 1, 2016 Accepting new patients

Locations

555 Gettysburg Pike
Ste C300
Mechanicsburg, PA 17055
Phone (717) 458-8840

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

Organizations & group practices 2

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1336177443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 GETTYSBURG PIKE STE C300",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170555206",
            "telephone_number": "717-458-8840",
            "fax_number": "717-795-4138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTELAC",
        "first_name": "PAULINE",
        "middle_name": "HRICISAK",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS007429L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0070574900003",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "paulinekostelacdo@fpc.medentdirect.com",
            "affiliation": "Y",
            "affiliationName": "FAMILY PRACTICE CENTER, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "555 Gettysburg Pike Ste C300",
            "city": "Mechanicsburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170555206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PAULINE",
            "last_name": "HRICISAK",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mechanicsburg, PA

Sources for this page

Verify at the official NPI Registry.