Prakorb Medical Associate Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

033993L Issued in PA

Legal business name

PRAKORB MEDICAL ASSOCIATE INC.

Practice address

129 Simpson Rd
Brownsville, PA 15417-9689

Phone

(724) 785-9696

Fax

(724) 785-7225

NPI assigned

Jun 13, 2010

Organization subpart

No

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

Authorized official

Name

Prakorb Isariyawongse, M.D.NPI 1912012022

Title

Owner

Phone

(724) 785-9696

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prakorb Isariyawongse, MD

  • General Practice Physician
  • Brownsville, PA
  • NPI 1912012022

  Surgery

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1276387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276387200000",
    "number": "1902127095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 SIMPSON RD",
            "city": "BROWNSVILLE",
            "state": "PA",
            "postal_code": "154179689",
            "telephone_number": "724-785-9696",
            "fax_number": "724-785-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 SIMPSON RD",
            "city": "BROWNSVILLE",
            "state": "PA",
            "postal_code": "154179689",
            "telephone_number": "724-785-9696",
            "fax_number": "724-785-7225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAKORB MEDICAL ASSOCIATE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-13",
        "last_updated": "2010-06-13",
        "status": "A",
        "authorized_official_last_name": "ISARIYAWONGSE",
        "authorized_official_first_name": "PRAKORB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-785-9696",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "PA",
            "license": "033993L",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "033993L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000586924 0003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Brownsville, PA
• Providers in Brownsville, PA by specialty
• Multi-Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.