Jody Lin Mrakovich, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA001689L Issued in PA

Practice address

1100 Spring Garden Dr
Middletown, PA 17057-3257

Phone

(717) 985-9091

Fax

(717) 985-6909

NPI assigned

Apr 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jody Lin Truesdale Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Bruce S Bashline D.O. Inc.

  • Family Medicine Physician
  • Middletown, PA
  • NPI 1780711333
  Medicare reassignment

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1952368342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SPRING GARDEN DR STE 3",
            "city": "MIDDLETOWN",
            "state": "PA",
            "postal_code": "170573257",
            "telephone_number": "717-985-9091",
            "fax_number": "717-985-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SPRING GARDEN DR",
            "city": "MIDDLETOWN",
            "state": "PA",
            "postal_code": "170573257",
            "telephone_number": "717-985-9091",
            "fax_number": "717-985-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRAKOVICH",
        "first_name": "JODY",
        "middle_name": "LIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA001689L",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA000187L",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001689L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODY",
            "last_name": "TRUESDALE",
            "middle_name": "LIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Middletown Functional Center PC
• Desirae Miller
• Kirsten Elaine Miller, FNP-BC
• Melissa Ann Mills, CRNP
• Charlotte Moyer, COTA
• Deanna Renee Murphy, LMT
• Munima Nasir, M.D.
• Andrew J Naumann, LPN, NRP
• Sarah Nelson
• Amy Keegan Nicholson, DC

• Medical Physician Assistant in Middletown, PA
• Providers in Middletown, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.