NPIMap

Individual provider Active NPI

Mark J Micciche, DPM

  • Podiatrist
  • Scranton, PA
National Provider Identifier
1336195031
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SC-003638-L Issued in PA
Practice address
1800 Mulberry St
Scranton, PA 18510-2369
Phone
(570) 703-8146
Fax
(570) 703-7205
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X SC-003638-L PA Primary

Addresses

Primary practice location

1800 Mulberry St
Scranton, PA 18510-2369

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0015256920005MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmicciche102075@direct.geisinger.edu Direct

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
I20040811000159 PA Practitioner - Podiatry 1759353618 Reassigns benefits to 2 organizations
Practice locations: Hawley, PA; Honesdale, PA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

531 Mt Pleasant Dr
Scranton, PA 18503-1987
Phone (570) 342-8500

Hospital & facility affiliations

  • Geisinger-Community Medical Center Hospital, Scranton, PA, CCN 390001

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue69
Removal of nail tissue232
Removal or shaving of skin growth90

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC-003638-LPAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Laporta and Associates,PC Podiatrist CurrentSince Sep 1, 2010 Accepting new patients
Geisinger Clinic CurrentSince May 1, 2020 Accepting new patients
Geisinger Clinic CurrentSince May 1, 2020 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic PastSince Sep 1, 2010 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

414 E Drinker St
Ste 101
Dunmore, PA 18512

601 Park St
Honesdale, PA 18431
Phone (570) 253-8100

600 Maple Ave
#1
Honesdale, PA 18431

531 Mt Pleasant Dr
Scranton, PA 18503
Phone (570) 342-8500

1800 Mulberry St
Scranton, PA 18510
Phone (570) 703-7351

300 Lackawanna Ave
Scranton, PA 18503
Phone (570) 342-7864

Interoperability endpoints

  • Direct secure messaging: mmicciche102075@direct.geisinger.edu

Organizations & group practices 5

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1336195031",
    "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": "1800 MULBERRY ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185102369",
            "telephone_number": "570-703-8146",
            "fax_number": "570-703-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICCICHE",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC-003638-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015256920005",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmicciche102075@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1800 Mulberry St",
            "city": "Scranton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "185102369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.