Individual provider Active NPI

Nicholas Paul Cunningham

  • Physician Assistant
  • Du Bois, PA
National Provider Identifier
1881276244
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA062583 Issued in PA
Practice address
621 S Main St
Du Bois, PA 15801-1413
Phone
(814) 299-7520
Fax
(814) 375-7798
NPI assigned
Apr 26, 2021
Last updated
Sep 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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 MA062583 PA Primary

Addresses

Primary practice location

621 S Main St
Du Bois, PA 15801-1413

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-4024

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211210001387 PA Practitioner - Physician Assistant 8022408731 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

26 Bolivar Dr
Bradford, PA 16701-3125
Phone (814) 817-4690

655 E Dubois Ave
Du Bois, PA 15801-3605
Phone (814) 913-3097

917 S Saint Marys St
Saint Marys, PA 15857-2828
Phone (814) 389-1026

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Brookville Hospital Physician Assistant CurrentSince Sep 29, 2021 Accepting new patients
Dubois Regional Medical Center Physician Assistant CurrentSince Sep 7, 2021 Accepting new patients
Dubois Regional Medical Center CurrentSince Sep 7, 2021 Accepting new patients
Brookville Hospital Physician Assistant CurrentSince Sep 29, 2021 Accepting new patients
Wellnow Urgent Care, PC CurrentSince Oct 24, 2022 Accepting new patients
Wellnow Urgent Care Practice, PC Past Accepting new patients

Locations

26 Bolivar Dr
Bradford, PA 16701
Phone (814) 817-4690

100 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1408

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

621 S Main St
Dubois, PA 15801
Phone (814) 299-7520

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1881276244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-375-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S MAIN ST",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011413",
            "telephone_number": "814-299-7520",
            "fax_number": "814-375-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "NICHOLAS",
        "middle_name": "PAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.