Active NPI
Martin G. Maksimak, M.D.
- Pediatric Gastroenterology Physician
- Danville, PA
National Provider Identifier
1699736249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- MD029469E
- Practice address
- 100 N Academy Ave
Danville, PA 17822-1320 - Phone
- (570) 271-6052
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | MD029469E | PA | Primary |
Addresses
Primary practice location
100 N Academy Ave
Danville, PA 17822-1320
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000910866 | Medicaid | PA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mmaksimak823@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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050726000394 | PA | Practitioner - Pediatric Medicine | 9436186020 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD029469E | PA | MD | Pediatric Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Past | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
316 Mauch Chunk St
#577885
Pottsville, PA 17901
Phone (570) 622-2291
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 and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
-
- Family Medicine Physician
- Scranton, PA
- NPI 1932534799
-
- Family Medicine Physician
- Pottsville, PA
- NPI 1043261183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1699736249",
"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": "100 N ACADEMY AVE",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178221320",
"telephone_number": "570-271-6052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAKSIMAK",
"first_name": "MARTIN",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "PA",
"license": "MD029469E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000910866",
"state": "PA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mmaksimak823@direct.geisinger.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "100 N Academy Ave",
"city": "Danville",
"state": "PA",
"country_code": "US",
"postal_code": "178221320",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Danville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.