NPIMap

Organization Active NPI

Northeast Gastroenterology Center, Inc.

  • Certified Registered Nurse Anesthetist
  • Hazle Township, PA
National Provider Identifier
1972854446
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
NORTHEAST GASTROENTEROLOGY CENTER, INC.
Practice address
10 Park PL
Hazle Township, PA 18202-2885
Phone
(570) 454-1400
Fax
(570) 454-2144
NPI assigned
Sep 25, 2012
Last updated
Sep 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

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

Authorized official

Name
Young Kul Yoo, MD
Title
President
Phone
(570) 454-1400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

10 Park PL
Hazle Township, PA 18202-2885

Mailing address

10 Park PL
Hazle Township, PA 18202-2885
Phone (570) 454-1400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040708000131 PA Part B Supplier - Clinic/Group Practice 2264410224 Receives reassigned benefits from 30 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hazle Township, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1972854446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PARK PL",
            "city": "HAZLE TOWNSHIP",
            "state": "PA",
            "postal_code": "182022885",
            "telephone_number": "570-454-1400",
            "fax_number": "570-454-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PARK PL",
            "city": "HAZLE TOWNSHIP",
            "state": "PA",
            "postal_code": "182022885",
            "telephone_number": "570-454-1400",
            "fax_number": "570-454-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GASTROENTEROLOGY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-25",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "YOO",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "KUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-454-1400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazle Township, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.