Active NPI
Kathleen Bannerman, MD
- Family Medicine Physician
- Kingston, PA
National Provider Identifier
1629652219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD485646
- Practice address
- 560 Pierce St
Kingston, PA 18704-5716 - Phone
- (570) 283-2161
- NPI assigned
- May 10, 2021
- Last updated
- Aug 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MT222612 | PA | |
| Family Medicine Physician | 207Q00000X | MD485646 | PA | Primary |
Addresses
Primary practice location
560 Pierce St
Kingston, PA 18704-5716
Mailing address
34 S Railroad St
Tamaqua, PA 18252-1927
Phone (570) 645-1950
Other practice location 1
411 S Shenandoah Rd
Ringtown, PA 17967-9432
Phone (570) 645-1951
Other practice location 2
530 Centre St
Ashland, PA 17921-1330
Phone (570) 645-1670
Other practice location 3
1254 Interchange Rd
Lehighton, PA 18235-9069
Phone (484) 426-2050
Other practice location 4
100 W Patterson St
Lansford, PA 18232-1304
Phone (272) 639-5020
Other practice location 5
34 S Railroad St
Tamaqua, PA 18252-1927
Phone (570) 645-1950
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Phoenix Rehabilitation and Health Services Inc
Practice addresses (Care Compare)
2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238
560 Pierce St
Kingston, PA 18704-5716
Phone (570) 714-5810
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT222612 | PA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Medical Oncology Selinsgrove | Current | Accepting new patients | |
| Geisinger Clinic | Family Medicine | Current | Accepting new patients |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic GYN Onc | Past | Accepting new patients |
Locations
114 Lt Michael Cleary Dr
Dallas, PA 18612
Phone (570) 255-1178
100 N Academy Ave
Danville, PA 17822
499 Wyoming Ave
Kingston, PA 18704
Phone (570) 283-2161
560 Pierce St
Kingston, PA 18704
Phone (570) 283-2161
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.
-
- Family Medicine Physician
- Danville, PA
- NPI 1366493868
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
-
- Medical Oncology Physician
- Selinsgrove, PA
- NPI 1003218900
-
- Obstetrics Physician
- Wilkes Barre, PA
- NPI 1346208709
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Aveanna Home Health
- Home Health Agency
- West Pittston, PA
- NPI 1376762237
-
- Home Health Agency
- East Stroudsburg, PA
- NPI 1083859516
-
- Home Health Agency
- Wilkes Barre, PA
- NPI 1619901527
-
dba Geisinger Pittston Radiology, a Service of GWV
- Diagnostic Radiology Physician
- Pittston, PA
- NPI 1104292960
Hospital
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1174822068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1629652219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 S RAILROAD ST",
"city": "TAMAQUA",
"state": "PA",
"postal_code": "182521927",
"telephone_number": "570-645-1950",
"fax_number": "570-645-1950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 PIERCE ST",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187045716",
"telephone_number": "570-283-2161"
}
],
"practiceLocations": [
{
"address_1": "411 S Shenandoah Rd",
"address_purpose": "LOCATION",
"city": "Ringtown",
"state": "PA",
"postal_code": "179679432",
"country_code": "US",
"telephone_number": "570-645-1951",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "530 Centre St",
"address_purpose": "LOCATION",
"city": "Ashland",
"state": "PA",
"postal_code": "179211330",
"country_code": "US",
"telephone_number": "570-645-1670",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1254 Interchange Rd",
"address_purpose": "LOCATION",
"city": "Lehighton",
"state": "PA",
"postal_code": "182359069",
"country_code": "US",
"telephone_number": "484-426-2050",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 W Patterson St",
"address_purpose": "LOCATION",
"city": "Lansford",
"state": "PA",
"postal_code": "182321304",
"country_code": "US",
"telephone_number": "272-639-5020",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "34 S Railroad St",
"address_purpose": "LOCATION",
"city": "Tamaqua",
"state": "PA",
"postal_code": "182521927",
"country_code": "US",
"telephone_number": "570-645-1950",
"fax_number": "570-645-1950",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BANNERMAN",
"first_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-10",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PA",
"license": "MT222612",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD485646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.