NPIMap

Organization Active NPI

Northeastern Gastroenterology Associates, PC

  • Gastroenterology Physician
  • Honesdale, PA
National Provider Identifier
1942211248
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
NORTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
Practice address
1860 Fair Ave
Suite a
Honesdale, PA 18431-2108
Phone
(570) 253-3391
Fax
(570) 253-1811
NPI assigned
Aug 11, 2006
Last updated
May 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name
Dr. David Dewitt Reynolds, M.D.NPI 1003829474
Title
President
Phone
(570) 253-3991

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

1860 Fair Ave
Suite a
Honesdale, PA 18431-2108

Mailing address

1860 Fair Ave
Suite a
Honesdale, PA 18431-2108
Phone (570) 253-3391

Other identifiers 6

IdentifierTypeStateIssuer
2400697OtherGHI
77790OtherPABLUE SHIELD 65 SPECIAL
804251OtherPAFIRST PRIORITY
0016721410006MedicaidPA
0450817000OtherAMERIHEALTH & INDEP BS
66362OtherPABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000149 PA Part B Supplier - Clinic/Group Practice 7113990912 Receives reassigned benefits from 10 practitioners
Practice locations: Blakely, PA; Honesdale, PA

National Provider Directory

National Provider Directory

Locations

2812 Scranton Carbondale Hwy
Blakely, PA 18447

2812 Scranton Carbondale Hwy
#103
Blakely, PA 18447

2812 Scranton Carbondale Hwy
Ste 103
Blakely, PA 18447
Phone (570) 253-3391

1860 Fair Ave
Ste A
Honesdale, PA 18431
Phone (570) 253-3391

310 Sunrise Ave
Honesdale, PA 18431
Phone (570) 253-4255

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1942211248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 FAIR AVE",
            "address_2": "SUITE A",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184312108",
            "telephone_number": "570-253-3391",
            "fax_number": "570-253-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 FAIR AVE",
            "address_2": "SUITE A",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184312108",
            "telephone_number": "570-253-3391",
            "fax_number": "570-253-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "DEWITT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-253-3991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2400697",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD 65 SPECIAL",
            "identifier": "77790",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "804251",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016721410006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH & INDEP BS",
            "identifier": "0450817000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "66362",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honesdale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; 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.