NPIMap

Individual provider Active NPI

Mayank R Modi, MD

  • Cardiovascular Disease Physician
  • Wyomissing, PA
National Provider Identifier
1790775153
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD059078L Issued in PA
Practice address
2605 Keiser Blvd
Wyomissing, PA 19610
Phone
(610) 685-8500
Fax
(610) 378-5131
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD059078L PA Primary

Addresses

Primary practice location

2605 Keiser Blvd
Wyomissing, PA 19610

Mailing address

2605 Keiser Blvd
Wyomissing, PA 19610
Phone (610) 685-8500

Other identifiers 1

IdentifierTypeStateIssuer
0017526450004MedicaidPA

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
I20060104000020 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Critical Care (Intensivists)Practitioner - Advanced Heart Failure and Transplant Cardiology 2961424072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Advanced Heart Failure and Transplant Cardiology, Critical Care (Intensivists)
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penn State Health Medical Group LLCGroup PAC ID 8729351077, 720 clinicians

Practice addresses (Care Compare)

2605 Keiser Blvd
Wyomissing, PA 19610-3338
Phone (670) 685-8500

Hospital & facility affiliations

  • Penn State Health St. Joseph Hospital, Reading, PA, CCN 390096
  • Reading Hospital Hospital, West Reading, PA, CCN 390044
  • St Lukes Hospital Hospital, Bethlehem, PA, CCN 390049
  • Pottstown Hospital Hospital, Pottstown, PA, CCN 390123
  • Wellspan Ephrata Community Hospital Hospital, Ephrata, PA, CCN 390225

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD059078LPAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Jan 1, 2019 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2018 Accepting new patients
The Milton S Hershey Medical Center Physcian Group CurrentSince Jan 1, 2019 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2018 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Penn State Health Medical Group, LLC Cardiovascular Disease Past Accepting new patients
Berks Vascular Institute, PC Past Accepting new patients
Penn State Health Medical Group, LLC PastSince Dec 9, 2019 Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

2605 Keiser Blvd
Wyomissing, PA 19610
Phone (610) 685-8500

Interoperability endpoints

  • Direct secure messaging: mayankmodi@bcl.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Penn State Health St JosephReading, PA, CCN 390096 Hospital Corporate Director Jul 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790775153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 KEISER BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "19610",
            "telephone_number": "610-685-8500",
            "fax_number": "610-378-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 KEISER BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "19610",
            "telephone_number": "610-685-8500",
            "fax_number": "610-378-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "MAYANK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD059078L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017526450004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyomissing, PA

Sources for this page

Verify at the official NPI Registry.