Individual provider Active NPI

Kristina Marie Demarco, MSPT

  • Specialist
  • Wilkes Barre, PA
National Provider Identifier
1922354273
Registry record updated Dec 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
DAPT003258 Issued in PA
Practice address
1140 Highway 315
Suite 207
Wilkes Barre, PA 18711-0911
Phone
(570) 970-0402
NPI assigned
Jul 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X DAPT003258 PA Primary
Physical Therapist 225100000X 40QA01442600 NJ

Addresses

Primary practice location

1140 Highway 315
Suite 207
Wilkes Barre, PA 18711-0911

Mailing address

1140 Highway 315
Suite 207
Wilkes Barre, PA 18711-0911
Phone (570) 970-0402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161215000697 PA Practitioner - Physical Therapist in Private Practice 6709032519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elmtree Wellness Center IncGroup PAC ID 4486939022, 14 clinicians

Practice addresses (Care Compare)

2489 Route 6
Suite 6
Hawley, PA 18428-6144
Phone (570) 390-7900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DAPT003258PAMDSpecialist
40QA01442600NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elmtree Wellness Center, Inc. CurrentSince Sep 23, 2020 Accepting new patients
Sports Care and Physical Rehabilitation Inc. Physical Therapist PastSince Jul 30, 2012 Accepting new patients
Elite Spine and Sports Physical Therapy LP Physical Therapist PastSince Dec 18, 2022 Accepting new patients

Locations

2489 Route 6
Ste 6
Hawley, PA 18428
Phone (570) 218-7909

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481760000000",
    "number": "1922354273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 HIGHWAY 315",
            "address_2": "SUITE 207",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110911",
            "telephone_number": "570-970-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 HIGHWAY 315",
            "address_2": "SUITE 207",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110911",
            "telephone_number": "570-970-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMARCO",
        "first_name": "KRISTINA",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-24",
        "last_updated": "2016-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "DAPT003258",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01442600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.