Individual provider Active NPI

Kylen Larue, PA-C

  • Medical Physician Assistant
  • Wilkes Barre, PA
National Provider Identifier
1699257576
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027
Phone
(570) 808-7300
NPI assigned
Sep 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027

Mailing address

139 Basin Hill Rd
Duncannon, PA 17020-9649
Phone (717) 756-6713

Other practice location 1

6481 Carlisle Pike
Mechanicsburg, PA 17050-2377
Phone (717) 796-9355

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
I20190109000406 PA Practitioner - Physician Assistant 7810233004 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ucmg LLCGroup PAC ID 6709398969, 254 clinicians

Practice addresses (Care Compare)

1221 Scalp Ave
Johnstown, PA 15904-3150
Phone (814) 266-1138

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services CurrentSince Nov 13, 2022 Accepting new patients
Geisinger Clinic CurrentSince Dec 17, 2018 Accepting new patients
Pinnacle Health Medical Services CurrentSince Nov 13, 2022 Accepting new patients
Geisinger Clinic CurrentSince Dec 17, 2018 Accepting new patients
Ucmg LLC CurrentSince Aug 6, 2025 Accepting new patients

Locations

4655 William Flynn Hwy
Ste 110
Allison Park, PA 15101
Phone (412) 486-3027

100 N Academy Ave
Danville, PA 17822

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

1221 Scalp Ave
Johnstown, PA 15904
Phone (814) 248-1225

6481 Carlisle Pike
Mechanicsburg, PA 17050
Phone (717) 516-6396

Interoperability endpoints

  • Direct secure messaging: klarue21401@gohealthupmc.direct-ci.com

Organizations & group practices 7

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": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1699257576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 BASIN HILL RD",
            "city": "DUNCANNON",
            "state": "PA",
            "postal_code": "170209649",
            "telephone_number": "717-756-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6481 Carlisle Pike",
            "address_purpose": "LOCATION",
            "city": "Mechanicsburg",
            "state": "PA",
            "postal_code": "170502377",
            "country_code": "US",
            "telephone_number": "717-796-9355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARUE",
        "first_name": "KYLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-06",
        "last_updated": "2025-09-11",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.