Mallory Kay Racoski, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA054645 Issued in PA

Practice address

5950 Sr 6 FL 4
Tunkhannock, PA 18657

Phone

(570) 836-6808

Fax

(570) 836-5536

NPI assigned

Sep 17, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mallory Kay Wintermute Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mracoski@thewrightcenter.medentdirect.com

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.

• The Wright Center Medical Group

  • Internal Medicine Physician
  • Scranton, PA
  • NPI 1194739979
  Medicare reassignment NPD

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1780992230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 SR 6 FL 4",
            "city": "TUNKHANNOCK",
            "state": "PA",
            "postal_code": "186577905",
            "telephone_number": "570-836-6808",
            "fax_number": "570-836-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 SR 6 FL 4",
            "city": "TUNKHANNOCK",
            "state": "PA",
            "postal_code": "18657",
            "telephone_number": "570-836-6808",
            "fax_number": "570-836-5536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 N State St",
            "address_purpose": "LOCATION",
            "city": "Clarks Summit",
            "state": "PA",
            "postal_code": "184111097",
            "country_code": "US",
            "telephone_number": "570-586-1134",
            "fax_number": "570-586-1136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 Main St",
            "address_purpose": "LOCATION",
            "city": "Peckville",
            "state": "PA",
            "postal_code": "184522078",
            "country_code": "US",
            "telephone_number": "570-383-0236",
            "fax_number": "570-383-3681",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "417 Main St",
            "address_purpose": "LOCATION",
            "city": "Laceyville",
            "state": "PA",
            "postal_code": "186236821",
            "country_code": "US",
            "telephone_number": "570-869-0120",
            "fax_number": "570-869-0124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACOSKI",
        "first_name": "MALLORY",
        "middle_name": "KAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-17",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA054645",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA004422",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "WINTERMUTE",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Susan Pizano
• Emily Elizabeth Podminick
• Mary Rose Powell
• Precise Compounding Inc. (Tunkhannock Compounding Center)
• Richard Shane Quanstrom, LCSW
• Taylor Alma Ray
• Marjorie Redan, R.D., L.D.N.
• Caley Reeves, SLP
• Renal Life Link Inc (Tunkhannock Dialysis)
• Sare Mae Rhodes, DMD

• Medical Physician Assistant in Tunkhannock, PA
• Providers in Tunkhannock, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; 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.