NPIMap

Individual provider Active NPI

Jeremy Joseph Hanlon, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • State College, PA
National Provider Identifier
1881949766
Registry record updated Aug 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DS039115 Issued in PA
Practice address
200 W Beaver Ave Ste 100
State College, PA 16801-4820
Phone
(800) 446-5680
NPI assigned
Jul 17, 2012
Last updated
Aug 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS039115 PA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS039115 PA Primary

Addresses

Primary practice location

200 W Beaver Ave Ste 100
State College, PA 16801-4820

Mailing address

200 W Beaver Ave Ste 100
State College, PA 16801-4820
Phone (800) 446-5680

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
I20230505001119 PA Practitioner - Oral Surgery 9032331517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-County Oral-Facial Surgeons PCGroup PAC ID 9436050911, 2 clinicians

Practice addresses (Care Compare)

200 W Beaver Ave
Suite 100
State College, PA 16801-4820
Phone (814) 238-0587

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS039115PAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-County Oral-Facial Surgeons, PLLC Oral and Maxillofacial Surgery CurrentSince May 8, 2023 Accepting new patients
Kurowski MD Spine and Pain Management LLC PastSince Jan 19, 2025 Accepting new patients

Locations

930 Bellefonte Ave
Ste 101
Lock Haven, PA 17745
Phone (570) 893-1702

200 W Beaver Ave
Ste 100
State College, PA 16801
Phone (814) 238-0587

Organizations & group practices 2

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1881949766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W BEAVER AVE STE 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014820",
            "telephone_number": "800-446-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W BEAVER AVE STE 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014820",
            "telephone_number": "800-446-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLON",
        "first_name": "JEREMY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-17",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039115",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS039115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.