NPIMap

Individual provider Active NPI

Tory Jane Miksiewicz Clugston, M.D

  • Family Medicine Physician
  • Blandon, PA
National Provider Identifier
1891107140
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD458193 Issued in PA
Practice address
850 Golden Dr Ste 1
Blandon, PA 19510-9657
Phone
(610) 944-5555
Fax
(610) 944-5551
NPI assigned
May 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT206657 PA
Family Medicine Physician 207Q00000X MD458193 PA Primary

Addresses

Primary practice location

850 Golden Dr Ste 1
Blandon, PA 19510-9657

Mailing address

PO Box 783311
Philadelphia, PA 19178-3311
Phone (484) 884-4500

Other names 1

  • Tory Jane Miksiewicz Former name

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
I20170629000032 PA Practitioner - Family Practice 1759676901 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pennsylvania State University College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

14351 Kutztown Rd
Fleetwood, PA 19522-9273
Phone (610) 944-8800

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

2100 Mack Blvd
FL 4
Allentown, PA 18103-5622

384 Airport Rd
Hazle Township, PA 18202-3325
Phone (570) 861-8717

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group Family Medicine CurrentSince Jul 10, 2017 Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Jul 10, 2017 Accepting new patients
Family Care Centers Inc Family Medicine CurrentSince Jun 21, 2024 Accepting new patients
Lehigh Valley Physician Group Family Medicine Current Accepting new patients
Schuylkill Health System Medical Group, Inc. Family Medicine Current Accepting new patients
Schuylkill Health System Medical Group, Inc. Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Family Care Centers Inc. Family Medicine Current Accepting new patients

Locations

2100 Mack Blvd
Allentown, PA 18103
Phone (484) 224-1892

850 Golden Dr
Ste 1
Blandon, PA 19510
Phone (610) 944-5555

120 Burrus Blvd
Brodheadsville, PA 18322
Phone (570) 402-6101

200 E Brown St
East Stroudsburg, PA 18301
Phone (570) 476-3700

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

14351 Kutztown Rd
Fleetwood, PA 19522
Phone (610) 944-8800

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

200 Schuylkill Medical Plz
Pottsville, PA 17901
Phone (570) 621-9200

700 Schuylkill Manor Rd
Ste 3
Pottsville, PA 17901
Phone (570) 621-4440

Interoperability endpoints

  • Direct secure messaging: tmiksiewiczclugston177273@direct2.lvhn.org

Organizations & group practices 8

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891107140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 783311",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191783311",
            "telephone_number": "484-884-4500",
            "fax_number": "484-884-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 GOLDEN DR STE 1",
            "city": "BLANDON",
            "state": "PA",
            "postal_code": "195109657",
            "telephone_number": "610-944-5555",
            "fax_number": "610-944-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKSIEWICZ CLUGSTON",
        "first_name": "TORY",
        "middle_name": "JANE",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT206657",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD458193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TORY",
            "last_name": "MIKSIEWICZ",
            "middle_name": "JANE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Blandon, PA

Sources for this page

Verify at the official NPI Registry.