Individual provider Active NPI

David J. Yatsonsky, MD

  • Internal Medicine Physician
  • Wilkes Barre, PA
National Provider Identifier
1790737484
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD050687L Issued in PA
Practice address
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040
Phone
(570) 829-2621
Fax
(570) 823-4332
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD050687L PA Primary

Addresses

Primary practice location

175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040

Mailing address

100 N Academy Ave
Danville, PA 17822-3034
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
001462538MedicaidPA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000172 PA Practitioner - Internal Medicine 3476510447 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD050687LPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Physician Group Inc CurrentSince Sep 1, 2016 Accepting new patients
St. Luke'S Physician Group, Inc. Current Accepting new patients
St. Luke'S Physician Group, Inc. CurrentSince Sep 1, 2016 Accepting new patients

Locations

3180 Route 611
Ste 22
Bartonsville, PA 18321
Phone (570) 629-1700

4311 Easton Ave
Bethlehem, PA 18020
Phone (610) 954-3600

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Organizations & group practices 3

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369180800000",
    "number": "1790737484",
    "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": "178223034",
            "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": "175 S WILKES BARRE BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187025040",
            "telephone_number": "570-829-2621",
            "fax_number": "570-823-4332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YATSONSKY",
        "first_name": "DAVID",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD050687L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001462538",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.