Individual provider Active NPI

Nico Edward Vasquez, PA-C

  • Physician Assistant
  • Scranton, PA
National Provider Identifier
1578226387
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA063090 Issued in PA
Practice address
3 W Olive St
Scranton, PA 18508-2572
Phone
(570) 961-3826
NPI assigned
Oct 19, 2021
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA063090 PA Primary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X MA063090 PA

Addresses

Primary practice location

3 W Olive St
Scranton, PA 18508-2572

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211214000036 PA Practitioner - Physician Assistant 8123418738 Reassigns benefits to 1 organization
I20231128002390 NC Practitioner - Physician Assistant 8123418738 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Specialists of North Carolina, P.a.Group PAC ID 7810974375, 49 clinicians
Raleigh Orthopaedic Clinic PAGroup PAC ID 9032012638, 125 clinicians

Practice addresses (Care Compare)

11221 Galleria Ave
Suite 101
Raleigh, NC 27614-8137
Phone (919) 562-9410

3001 Edwards Mill Rd
Suite 200
Raleigh, NC 27612-5243
Phone (919) 863-6856

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA063090PAMDSports Medicine (Neuromusculoskeletal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Orthopaedic Clinic PA CurrentSince Mar 4, 2026 Accepting new patients
Orthopaedic Specialists of North Carolina, P.a. CurrentSince Nov 14, 2023 Accepting new patients
Geisinger Clinic CurrentSince Dec 13, 2021 Accepting new patients
Geisinger Clinic Physician Assistant CurrentSince Dec 13, 2021 Accepting new patients
Orthopaedic Specialists of North Carolina, P.a. CurrentSince Nov 14, 2023 Accepting new patients

Locations

11081 Forest Pines Dr
Ste 112
Raleigh, NC 27614
Phone (252) 478-3736

11200 Governor Manly Way
Ste 309
Raleigh, NC 27614
Phone 9195629410247

11221 Galleria Ave
#101
Raleigh, NC 27614
Phone 9195629410213

3001 Edwards Mill Rd
Ste 200
Raleigh, NC 27612
Phone (919) 863-6852

5838 Six Forks Rd
Ste 100
Raleigh, NC 27609

100 N Academy Ave
Danville, PA 17822

3 W Olive St
Scranton, PA 18508
Phone (570) 207-4054

Interoperability endpoints

  • Direct secure messaging: nico.vasquez.1@12529.direct.athenahealth.com

Organizations & group practices 6

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 2

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": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1578226387",
    "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": "3 W OLIVE ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082572",
            "telephone_number": "570-961-3826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "NICO",
        "middle_name": "EDWARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-19",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA063090",
            "primary": true
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "PA",
            "license": "MA063090",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.