NPIMap

Individual provider Active NPI

Ifeanyi Bertram Nwadukwe, MD

  • Addiction Medicine (Preventive Medicine) Physician
  • Williamsport, PA
National Provider Identifier
1992207831
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
License
MD482489 Issued in PA
Practice address
425 Market St
Williamsport, PA 17701-6345
Phone
(570) 368-4477
Fax
(570) 368-4476
NPI assigned
Mar 7, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine Physician 2083P0901X 83915 GA
General Practice Physician 208D00000X 83915 GA
Addiction Medicine (Preventive Medicine) Physician 2083A0300X MD482489 PA Primary

Addresses

Primary practice location

425 Market St
Williamsport, PA 17701-6345

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230925001319 PA Practitioner - Addiction Medicine 3173953254 Reassigns benefits to 2 organizations
I20241025000399 NC Practitioner - Preventive Medicine 3173953254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Addiction Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

8 Church St
Wilkes Barre, PA 18765-3542
Phone (570) 808-3700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD482489PAMDAddiction Medicine (Preventive Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Sep 18, 2023 Accepting new patients
Geisinger Clinic CurrentSince Sep 18, 2023 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

425 E 1st St
Bloomsburg, PA 17815
Phone (570) 387-2474

100 N Academy Ave
Danville, PA 17822

21 Geisinger Ln
Lewistown, PA 17044
Phone (717) 242-4200

8 Church St
Wilkes Barre, PA 18702
Phone (570) 808-3700

Organizations & group practices 5

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.

Hospital & facility affiliations 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1992207831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 MARKET ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016345",
            "telephone_number": "570-368-4477",
            "fax_number": "570-368-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWADUKWE",
        "first_name": "IFEANYI",
        "middle_name": "BERTRAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-07",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "GA",
            "license": "83915",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "83915",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "PA",
            "license": "MD482489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.