Active NPI
Gavin Davis
- Physician Assistant
- Wilkes-Barre, PA
National Provider Identifier
1376410233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA067105
- Practice address
- 1175 E Mountain Blvd
Wilkes-Barre, PA 18702-7906 - Phone
- (570) 808-1093
- Fax
- (570) 808-7878
- NPI assigned
- Oct 23, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA067105 | PA | Primary |
Addresses
Primary practice location
1175 E Mountain Blvd
Wilkes-Barre, PA 18702-7906
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-1093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1175 E Mountain Blvd
Suite 150723
Wilkes Barre, PA 18702-7906
Phone (570) 808-1093
Hospital & facility affiliations
- Geisinger Wyoming Valley Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA067105 | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Past | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Danville, PA
- NPI 1366493868
-
- Pediatrics Physician
- Mountain Top, PA
- NPI 1538445218
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
-
- Hospitalist Physician
- Wilkes Barre, PA
- NPI 1588614358
Hospital & facility affiliations 20
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Diagnostic Radiology Physician
- Pittston, PA
- NPI 1104292960
Hospital
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1174822068
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1275620585
-
- General Acute Care Hospital
- Pittston, PA
- NPI 1316692585
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763596800000",
"number": "1376410233",
"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": "570-808-1093",
"fax_number": "570-808-7878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 E MOUNTAIN BLVD",
"city": "WILKES-BARRE",
"state": "PA",
"postal_code": "187027906",
"telephone_number": "570-808-1093",
"fax_number": "570-808-7878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "GAVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-10-23",
"last_updated": "2025-11-20",
"certification_date": "2025-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA067105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes-Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.