NPIMap

Individual provider Active NPI

Lora Denise Paulukonis, PA-C

  • Medical Physician Assistant
  • Wilkes Barre, PA
National Provider Identifier
1710939178
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA050793 Issued in PA
Practice address
575 N River St
Wilkes Barre, PA 18764-0999
Phone
(570) 552-1180
NPI assigned
May 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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 MA050793 PA Primary

Addresses

Primary practice location

575 N River St
Wilkes Barre, PA 18764-0999

Mailing address

4149 Bear Creek Blvd
Bear Creek TW, PA 18702-9749
Phone (570) 472-0226

Other names 1

  • Lora Denies Ellsworth Former name

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
I20060719000014 PA Practitioner - Physician Assistant 2466465430 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

200 Schuylkill Medical PLZ
Pottsville, PA 17901-3660
Phone (570) 621-9270

2100 Mack Blvd
FL 4
Allentown, PA 18103-5622

384 Airport Rd
Hazle Township, PA 18202-3325
Phone (570) 861-8717

5649 Wynnewood Dr
Laurys Station, PA 18059-1124

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Schuylkill Health System Medical Group, Inc. CurrentSince Jun 17, 2019 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 29, 2019 Accepting new patients
Pennsylvania Physician Services, LLC CurrentSince Feb 8, 2011 Accepting new patients
Pennsylvania Physician Services, LLC CurrentSince Feb 8, 2011 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 29, 2019 Accepting new patients
Atlantic Physician Services of Maryland, PC CurrentSince Nov 1, 2018 Accepting new patients
On Demand Urgent Care Group PC Past Accepting new patients
Humboldt Emergency Physicians LLC Past Accepting new patients
Regents of the University of California - Ucsd Medical Group Past Accepting new patients
Pulmonary Associates PC Past Accepting new patients

Locations

300 Highland Ave
Hanover, PA 17331
Phone (717) 316-3711

384 Airport Rd
Hazle Township, PA 18202
Phone (570) 501-1242

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

700 Schuylkill Manor Rd
Ste 3
Pottsville, PA 17901
Phone (570) 621-4440

700 E Norwegian St
Pottsville, PA 17901
Phone (570) 621-4000

200 Schuylkill Medical Plz
Pottsville, PA 17901
Phone (570) 621-9200

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

575 N River St
Wilkes Barre, PA 18764
Phone (570) 552-1300

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1710939178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4149 BEAR CREEK BLVD",
            "city": "BEAR CREEK TW",
            "state": "PA",
            "postal_code": "187029749",
            "telephone_number": "570-472-0226",
            "fax_number": "570-472-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187640999",
            "telephone_number": "570-552-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULUKONIS",
        "first_name": "LORA",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA050793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORA",
            "last_name": "ELLSWORTH",
            "middle_name": "DENIES",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.