NPIMap

Individual provider Active NPI

Bradley D Fenster, MD

  • Cardiovascular Disease Physician
  • Kingston, PA
National Provider Identifier
1952394314
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD073510L Issued in PA
Practice address
610 Wyoming Ave
Kingston, PA 18704-3702
Phone
(570) 283-5806
Fax
(570) 283-5807
NPI assigned
Aug 31, 2005
Last updated
Jan 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD073510L PA Primary

Addresses

Primary practice location

610 Wyoming Ave
Kingston, PA 18704-3702

Mailing address

610 Wyoming Ave
Kingston, PA 18704-3702
Phone (570) 288-5441

Other identifiers 1

IdentifierTypeStateIssuer
069319L3FOtherPAGROUP MEMBER PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bradley.fenster.1@21771.direct.athenahealth.com Direct

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
I20051207000530 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician)Practitioner - Interventional Cardiology 3476574377 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Georgetown University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

176 N Main St
Shavertown, PA 18708-1121
Phone (570) 675-0900

190 Welles St
Forty Fort, PA 18704-4968
Phone (570) 288-0400

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

545 N River St
Wilkes Barre, PA 18702-2600

575 N River St
Wilkes Barre, PA 18702-2634
Phone (570) 552-8938

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC CurrentSince Nov 15, 2023 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jan 1, 2008 Accepting new patients
Geisinger Clinic CurrentSince Jan 1, 2008 Accepting new patients

Locations

439 E 1st St
Bloomsburg, PA 17815
Phone (570) 387-1444

100 N Academy Ave
Danville, PA 17822

610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441

610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

1099 S Township Blvd
Pittston, PA 18640
Phone (570) 602-2400

575 N River St
Wilkes Barre Township, PA 18702
Phone (570) 283-3222

Organizations & group practices 4

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

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1952394314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702",
            "telephone_number": "570-288-5441",
            "fax_number": "570-288-5842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702",
            "telephone_number": "570-283-5806",
            "fax_number": "570-283-5807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSTER",
        "first_name": "BRADLEY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD073510L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEMBER PTAN",
            "identifier": "069319L3F",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bradley.fenster.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "EMR direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "610 Wyoming Ave",
            "city": "Kingston",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187043702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

Verify at the official NPI Registry.