Peter Lukasz Wilczanski, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD040751L Issued in PA

Practice address

5241 Buffalo Rd
Lakeshore Family Practice
Erie, PA 16510-2309

Phone

(814) 877-7686

Fax

(814) 877-7692

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Epn Hamot Urgent Care LLC

  • Family Medicine Physician
  • Erie, PA
  • NPI 1518283753
  Medicare reassignment NPD
• Erie Physicians Network PC

  • Multi-Specialty Clinic/Center
  • Erie, PA
  • NPI 1902844574
  NPD (past)

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1700874146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 STATE ST",
            "address_2": "SUITE 16",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011341",
            "telephone_number": "814-480-7100",
            "fax_number": "814-480-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 BUFFALO RD",
            "address_2": "LAKESHORE FAMILY PRACTICE",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165102309",
            "telephone_number": "814-877-7686",
            "fax_number": "814-877-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCZANSKI",
        "first_name": "PETER",
        "middle_name": "LUKASZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD040751L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00025573901",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011180320003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080081947",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "66429",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "P000383",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC",
            "identifier": "212709",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "522615",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY MEDICAID",
            "identifier": "01917019",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "015973",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William M Wilcko, DMD MS
• Lisa Wilcox
• Mary Wilcox, LCSW
• Philip Wilcox, MS OTR/L
• Halina B Wilczanski, DMD
• Eric Robert Wildauer, D.O
• Cohen Wildeson
• Brenda Leora Wiler, L.S.W.
• Brandon Wiley, MS
• William Christian Wilhelm, MD

• Family Medicine Physician in Erie, PA
• Providers in Erie, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.

Verify at the official NPI Registry.