NPIMap

Individual provider Active NPI

Eduardo Gabriel Ortiz, MD

  • Dermatology Physician
  • Wilkes Barre, PA
National Provider Identifier
1629537659
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD480839 Issued in PA
Practice address
1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone
(570) 808-6113
Fax
(570) 808-6349
NPI assigned
Mar 19, 2019
Last updated
Oct 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Dermatology Physician 207N00000X MD480839 PA Primary

Addresses

Primary practice location

1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906

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
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
I20231004002857 PA Practitioner - Dermatology 8325374127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone (570) 808-5135

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions245
Removal or shaving of skin growth1-10
Skin biopsy123

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD480839PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Sep 5, 2023 Accepting new patients
Geisinger Clinic CurrentSince Sep 5, 2023 Accepting new patients
Geisinger Clinic Dermatology 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 46

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

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1629537659",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027906",
            "telephone_number": "570-808-6113",
            "fax_number": "570-808-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ",
        "first_name": "EDUARDO",
        "middle_name": "GABRIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD480839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.