NPIMap

Individual provider Active NPI

Michael Vaughan Antoniacci

  • Physician Assistant
  • Scranton, PA
National Provider Identifier
1639050313
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA066899 Issued in PA
Practice address
5 Morgan Hwy
Scranton, PA 18508-2641
Phone
(570) 344-3788
NPI assigned
Sep 10, 2025
Last updated
Sep 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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 MA066899 PA Primary

Addresses

Primary practice location

5 Morgan Hwy
Scranton, PA 18508-2641

Mailing address

5 Morgan Hwy
Scranton, PA 18508-2641
Phone (570) 344-3788

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
I20251006001774 PA Practitioner - Physician Assistant 1153827308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

150 Mundy St
Wilkes Barre, PA 18702-6830
Phone (570) 824-0930

5 Morgan Hwy
Suite 4
Scranton, PA 18508-2641
Phone (570) 344-3788

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA066899PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Rehabilitation Associates, PC CurrentSince Oct 6, 2025 Accepting new patients

Locations

5 Morgan Hwy
Scranton, PA 18508
Phone (570) 344-3788

5 Morgan Hwy
Ste 4
Scranton, PA 18508
Phone (570) 344-3788

150 Mundy St
Wilkes Barre Township, PA 18702
Phone (570) 824-0930

Interoperability endpoints

  • Direct secure messaging: mantoniacci@nerehab.medentdirect.com

Organizations & group practices 1

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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1639050313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MORGAN HWY",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082641",
            "telephone_number": "570-344-3788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MORGAN HWY",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082641",
            "telephone_number": "570-344-3788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIACCI",
        "first_name": "MICHAEL",
        "middle_name": "VAUGHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-10",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA066899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.