Active NPI
Jeremiah W Eagen, MD
- Nephrology Physician
- Scranton, PA
National Provider Identifier
1487659744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- MD-021443-E
- Practice address
- 802 Jefferson Ave
Scranton, PA 18510-1038 - Phone
- (570) 348-0360
- Fax
- (570) 348-0362
- NPI assigned
- Jun 14, 2005
- Last updated
- Apr 23, 2014
- 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | MD-021443-E | PA | Primary |
Addresses
Primary practice location
802 Jefferson Ave
Scranton, PA 18510-1038
Mailing address
802 Jefferson Ave
Scranton, PA 18510-1038
Phone (570) 348-0360
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1187399 | Medicaid | PA | |
| 815507 | Other | PA | FIRST PRIORITY |
| 851436 | Other | PA | BLUE SHEILD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-021443-E | PA | MD | Nephrology Physician |
Organizations & group practices 1
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.
-
- Nephrology Physician
- Scranton, PA
- NPI 1386617967
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398211200000",
"number": "1487659744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 JEFFERSON AVE",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185101038",
"telephone_number": "570-348-0360",
"fax_number": "570-348-0362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 JEFFERSON AVE",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185101038",
"telephone_number": "570-348-0360",
"fax_number": "570-348-0362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGEN",
"first_name": "JEREMIAH",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2014-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "PA",
"license": "MD-021443-E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1187399",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY",
"identifier": "815507",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHEILD",
"identifier": "851436",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scranton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.