Individual provider Active NPI

Kevin L. Wheeler, RPAC

  • Physician Assistant
  • Sayre, PA
National Provider Identifier
1790751675
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA052165 Issued in PA
Practice address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone
(570) 888-5858
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000760-1 NY
Physician Assistant 363A00000X MA052165 PA Primary

Addresses

Primary practice location

1 Guthrie SQ
Sayre, PA 18840-1625

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Other identifiers 4

IdentifierTypeStateIssuer
CC9269OtherPARR MEDICARE GROUP
02079486MedicaidNY
P00260892OtherPARR MEDICARE PIN
GU039978OtherPAPA MEDICARE GROUP

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwheeler8020@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040528001245 NY Practitioner - Physician Assistant 7517948086 Reassigns benefits to 2 organizations
I20051004000102 PA Practitioner - Physician Assistant 7517948086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians

Practice addresses (Care Compare)

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

110 Plaza LN
Wellsboro, PA 16901-1773
Phone (570) 724-4241

130 Ctr Way
Corning, NY 14830-2255
Phone (607) 936-9971

One Guthrie SQ
Sayre, PA 18840-1625

One Guthrie Square
Sayre, PA 18840-1625

Hospital & facility affiliations

  • Robert Packer Hospital Hospital, Sayre, PA, CCN 390079
  • Corning Hospital Hospital, Corning, NY, CCN 330277

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000760-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Guthrie Medical Group, P.C. CurrentSince Jul 28, 2005 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Aug 18, 2021 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Aug 16, 2009 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jul 28, 2005 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Aug 18, 2021 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

130 Center Way
Corning, NY 14830
Phone (607) 936-9971

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

Interoperability endpoints

  • Direct secure messaging: kwheeler8020@direct-guthrie.org

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1790751675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "KEVIN",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "RPAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "000760-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CC9269",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02079486",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00260892",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICARE GROUP",
            "identifier": "GU039978",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwheeler8020@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1 Guthrie Sq",
            "city": "Sayre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "188401625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sayre, PA

Sources for this page

Verify at the official NPI Registry.