Individual provider Active NPI

Lillian Malcolm, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1649760323
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA059771 Issued in PA
Practice address
200 Scenery Dr
State College, PA 16801-7974
Phone
(814) 231-4560
Fax
(814) 231-6246
NPI assigned
May 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA059771 PA Primary
Medical Physician Assistant 363AM0700X MA059771 PA

Addresses

Primary practice location

200 Scenery Dr
State College, PA 16801-7974

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lmalcolm166193@direct.geisinger.edu Direct

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180530002052 PA Practitioner - Physician Assistant 8325303035 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Pittsburgh School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

200 Scenery Dr
State College, PA 16801-7974
Phone (814) 231-4560

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA059771PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture LLC CurrentSince Sep 1, 2019 Accepting new patients
Geisinger-HM Joint Venture, LLC Physician Assistant CurrentSince Sep 1, 2019 Accepting new patients
Geisinger Clinic CurrentSince Jun 18, 2018 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

1020 Thompson St
Jersey Shore, PA 17740
Phone (570) 398-0100

529 High St
Lock Haven, PA 17745
Phone (570) 743-1703

955 Bellefonte Ave
Lock Haven, PA 17745
Phone (570) 748-7714

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

132 Abigail Ln
Port Matilda, PA 16870
Phone (814) 272-5011

3 W Olive St
Ste 212
Scranton, PA 18508

200 Scenery Dr
State College, PA 16801
Phone (814) 231-4560

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1649760323",
    "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",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SCENERY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017974",
            "telephone_number": "814-231-4560",
            "fax_number": "814-231-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOLM",
        "first_name": "LILLIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059771",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA059771",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmalcolm166193@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "529 High St",
            "city": "Lock Haven",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177453029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.