NPIMap

Individual provider Active NPI

Marissa Dudeck, PA-C

  • Physician Assistant
  • Johnstown, PA
National Provider Identifier
1588718787
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA050660 Issued in PA
Practice address
1086 Franklin St
Johnstown, PA 15905-4305
Phone
(814) 534-9600
NPI assigned
Jan 23, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA050660 PA Primary

Addresses

Primary practice location

1086 Franklin St
Johnstown, PA 15905-4305

Mailing address

551 Main St
3Rd Floor
Johnstown, PA 15901-2032
Phone (814) 539-5724

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
I20070313000004 PA Practitioner - Physician Assistant 1153424148 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Physical Therapy and Rehabilitation IncGroup PAC ID 3072424886, 253 clinicians

Practice addresses (Care Compare)

1111 Franklin St
Johnstown, PA 15905-4341

336 Bloomfield St
Johnstown, PA 15904-3271
Phone (814) 269-2224

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA050660PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Conemaugh Physician Practices LLC Physician Assistant CurrentSince Mar 1, 2021 Accepting new patients
DLP Conemaugh Physician Practices LLC Physician Assistant CurrentSince Mar 1, 2021 Accepting new patients
DLP Conemaugh Memorial Medical Center LLC CurrentSince Sep 6, 2014 Accepting new patients
DLP Conemaugh Memorial Medical Center LLC CurrentSince Sep 6, 2014 Accepting new patients
Conemaugh Health Initiatives Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Conemaugh Valley Memorial Hospital Past Accepting new patients

Locations

236 Jamesway Rd
Ebensburg, PA 15931
Phone (814) 471-6595

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1086 Franklin St
#L
Johnstown, PA 15905

1111 Franklin St
Ste 180
Johnstown, PA 15905
Phone (814) 534-3740

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: mdudeck39921@direct.conemaugh.org

Organizations & group practices 10

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 5

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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588718787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 MAIN ST",
            "address_2": "3RD FLOOR",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159012032",
            "telephone_number": "814-539-5724",
            "fax_number": "814-536-7092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 FRANKLIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159054305",
            "telephone_number": "814-534-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDECK",
        "first_name": "MARISSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA050660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.