Pradeepto Ghosh, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Wilkes Barre, PA
NPI 1851679690 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1851679690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- MD472164 (PA)
- Practice address
- 1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027 - Phone
- (570) 808-6020
- NPI assigned
- Jul 27, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- District Medical Group Inc
Practice addresses (Care Compare)
2525 E Roosevelt St
Phoenix, AZ 85008-4948
Phone (602) 344-1015
Hospital & facility affiliations
- Valleywise Health Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201015002887 | PA | Practitioner - Cardiovascular Disease (Cardiology) | 3476862269 | Reassigns benefits to 1 organization |
| I20240417001989 | AZ | Practitioner - Internal Medicine |
3476862269 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT198647 | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Internal Medicine | Current |
Accepting new patients |
| Geisinger Clinic | Current |
Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| District Medical Group, Inc | Current |
Accepting new patients | |
| Geisinger Clinic | Current |
Accepting new patients | |
| Maricopa County Special Health Care District | Past | Accepting new patients | |
| District Medical Group, Inc | Internal Medicine | Past | Accepting new patients |
Locations
8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000
2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298
2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015
3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520
3141 N 3rd Ave
Ste 100
Phoenix, AZ 85013
Phone (602) 914-1520
2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043
5102 W Campbell Ave
Phoenix, AZ 85031
Phone (623) 848-5000
100 N Academy Ave
Danville, PA 17822
1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300
1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399
Interoperability endpoints
- pghosh260702@direct.valleywisehealth.org
- pghosh326319@direct.geisinger.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MT198647 | PA | |
| Cardiovascular Disease Physician | 207RC0000X | 51046 | KY | |
| Cardiovascular Disease Physician | 207RC0000X | MD472164 | PA | Yes |
Addresses
Primary practice location
1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144
Other practice location 1
100 E Lancaster Ave
Wynnewood, PA 19096-3450
Phone (484) 476-2000
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pghosh326319@direct.geisinger.edu | Direct |
Other providers in Wilkes Barre, PA
- Mallory Ann Getts
- Lynne Marie Getz
- Ggnsc Wilkes-Barre East Mountain LP
- Ggnsc Wilkes-Barre II LP
- Martha S. Ghosh
- Vincent Giannotti
- Pamela Giarratano
- Gerald P Gibbons Jr.
- Tammy Gibbons
- Martin Gilbert
All providers in Wilkes Barre, PA · Cardiovascular Disease Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.