NPIMap

Individual provider Active NPI

Kevin Kaczmarek, PA-C

  • Physician Assistant
  • Sunbury, PA
National Provider Identifier
1831138668
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA003203L Issued in PA
Practice address
130 N 4TH St
Sunbury, PA 17801-2211
Phone
(570) 286-1482
Fax
(570) 286-5243
NPI assigned
Jun 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

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
Physician Assistant 363A00000X MA003203L PA Primary

Addresses

Primary practice location

130 N 4TH St
Sunbury, PA 17801-2211

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other identifiers 1

IdentifierTypeStateIssuer
MA003203LOtherPALICENSE NUMBER

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
I20060814000318 PA Practitioner - Physician Assistant 1254334105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC CurrentSince Apr 1, 2002 Accepting new patients
Geisinger Clinic CurrentSince Apr 1, 2007 Accepting new patients
Geisinger Clinic Physician Assistant CurrentSince Apr 1, 2007 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

425 E 1st St
Ste 201
Bloomsburg, PA 17815
Phone (570) 387-2280

4203 Hospital Rd
Coal Township, PA 17866
Phone (570) 486-4588

100 N Academy Ave
Danville, PA 17822

100 N Academy Ave
#T
Danville, PA 17822

119 Nevada Dr
Kulpmont, PA 17834
Phone (570) 373-1250

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

Interoperability endpoints

  • Direct secure messaging: kkaczmarek76266@direct.geisinger.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831138668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N 4TH ST",
            "city": "SUNBURY",
            "state": "PA",
            "postal_code": "178012211",
            "telephone_number": "570-286-1482",
            "fax_number": "570-286-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZMAREK",
        "first_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA003203L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MA003203L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunbury, PA

Sources for this page

Verify at the official NPI Registry.