NPIMap

Individual provider Active NPI

Theodore L Hetrick Jr., MD

  • Emergency Medicine Physician
  • Lewistown, PA
National Provider Identifier
1619904497
Registry record updated Feb 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD018356E Issued in PA
Practice address
400 Highland Ave
Lewistown, PA 17044-1167
Phone
(717) 242-7180
Fax
(717) 242-7299
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 12

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 26

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

View all 26

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Temple University School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennsylvania Department of Human Services 34 clinicians

Practice addresses (Care Compare)

1000 US Hwy 522
Selinsgrove, PA 17870-8707
Phone (570) 372-5601

Hospital & facility affiliations

  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006

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
I20041018000850 PA Practitioner - Emergency Medicine 7012806797 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pennsylvania Department of Public Welfare CurrentSince Sep 6, 2017 Accepting new patients
Pennsylvania Department of Human Services CurrentSince Sep 6, 2017 Accepting new patients
Family Health Associates of Geisinger Lewistown Hospital Past Accepting new patients

Locations

1000 US Highway 522
Selinsgrove, PA 17870
Phone (570) 372-5601

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD018356E PA Primary

Addresses

NPPES NPI Registry

Primary practice location

400 Highland Ave
Lewistown, PA 17044-1167

Mailing address

400 Highland Ave
Lewistown, PA 17044-1167
Phone (717) 242-7180

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 12, 2008.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1619904497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "city": "LEWISTOWN",
            "state": "PA",
            "postal_code": "170441167",
            "telephone_number": "717-242-7180",
            "fax_number": "717-242-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "city": "LEWISTOWN",
            "state": "PA",
            "postal_code": "170441167",
            "telephone_number": "717-242-7180",
            "fax_number": "717-242-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETRICK",
        "first_name": "THEODORE",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD018356E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewistown, PA

Sources for this page

Verify at the official NPI Registry.