NPIMap

Individual provider Active NPI

Brian J Kobylus, DPM

  • Podiatrist
  • Scranton, PA
National Provider Identifier
1922070960
Registry record updated Sep 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SC004540L Issued in PA
Practice address
201 N Main Ave
Scranton, PA 18504-3303
Phone
(570) 342-4009
Fax
(570) 342-4326
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X SC004540L PA Primary

Addresses

Primary practice location

201 N Main Ave
Scranton, PA 18504-3303

Mailing address

201 N Main Ave
Scranton, PA 18504-3303
Phone (570) 342-4009

Other identifiers 3

IdentifierTypeStateIssuer
0018671600001MedicaidPA
66842OtherGEISINGER
813188OtherFIRST PRIORITY

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
I20111027000781 PA Practitioner - Podiatry 9931372406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richard T. Meredick, D.P.M., P.C.Group PAC ID 6507841947, 3 clinicians

Practice addresses (Care Compare)

201 N Main Ave
Scranton, PA 18504-3303
Phone (570) 342-4009

Hospital & facility affiliations

  • Geisinger-Community Medical Center Hospital, Scranton, PA, CCN 390001
  • Geisinger Wyoming Valley Medical Center Hospital, Wilkes Barre, PA, CCN 390270
  • Allied Services Institute of Rehabilitation Inpatient rehabilitation facility, Scranton, PA, CCN 393030

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue35
Removal of skin lesions14
Removal of nail tissue197
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Richard T Meredick DPM PC Podiatrist CurrentSince Jul 1, 2001 Accepting new patients

Locations

201 N Main Ave
Scranton, PA 18504
Phone (570) 342-4009

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1922070960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N MAIN AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185043303",
            "telephone_number": "570-342-4009",
            "fax_number": "570-342-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N MAIN AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185043303",
            "telephone_number": "570-342-4009",
            "fax_number": "570-342-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBYLUS",
        "first_name": "BRIAN",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC004540L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018671600001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "66842",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "813188",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.