INTERMOUNTAIN MEDICAL GROUP, INC (NPI# 1356397673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356397673 |
| Entity Type | Organization |
| Organization Name | INTERMOUNTAIN MEDICAL GROUP, INC |
| Practice Address |
610 Wyoming Ave Kingston PA 18704-3702 |
| Practice Telephone | 5702885441 |
| Practice Fax Number | 5702885842 |
| Mailing Telephone | 5702885441 |
| Mailing Fax Number | 5702885842 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2016-01-28 |
| Authorized Official Name | MRS. DONNA POWELL (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 5704080410 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
PA | Podiatric Medicine & Surgery Service Providers | |
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | HIGHMARK BLUE SHIELD | 1624037 | 01 |
| PW | HIGHMARK BLUE SHIELD | 510820 | 01 |
| PA | 100755627 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932271624 | Intermountain Medical Group, Inc | Clinical Medical Laboratory | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-11-15 |
| Street Address |
610 WYOMING AVE |
| City | KINGSTON |
| State | PA |
| Zip Code | 18704-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740723675 | Ashley K Marsh | Physician Assistant | 610 Wyoming Ave, Suite 1, Kingston, PA 18704-3702 | 2016-11-26 |
| 1558513168 | Kalyani R Meduri | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2008-10-14 |
| 1780847657 | Seema Kumari | Family Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2008-07-09 |
| 1710151527 | Karthik Penumetsa | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2008-04-14 |
| 1245423367 | Jaromir Kohout | Surgery | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2007-08-22 |
| 1932271624 | Intermountain Medical Group, Inc | Clinical Medical Laboratory | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-11-15 |
| 1487755591 | David F Rimple | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-09-25 |
| 1265545990 | Richard Abramowitz | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-08-16 |
| 1568475820 | Daniel K Silverstein | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-08-15 |
| 1215940580 | Cynthia Solomon | Internal Medicine | 610 Wyoming Ave, Kingston, PA 18704-3702 | 2006-08-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013557552 | Millmark Health Inc. | Psychiatry & Neurology | 511 Pierce Street, Kingston, PA 18704 | 2020-01-13 |
| 1427550334 | Michael Anthony Waltich | Military Health Care Provider | 82 Cooper Street, Pringle, PA 18704 | 2018-03-06 |
| 1376088435 | Jae LLC | Massage Therapist | 512 Northhampton Street, Edwardsville, PA 18704 | 2016-12-28 |
| 1306278288 | Mohammad Khaled Tashkandi | Internal Medicine | 490 Northampton St Ste 1, Edwardsville, PA 18704 | 2013-08-02 |
| 1396180014 | Sammie Craven IIi | Pharmacist | 96 1st Avenue, Kingston, PA 18704 | 2013-05-08 |
| 1447693114 | Catherine Mary Harding | Nurse Practitioner | 141 South Maple Ave, Kingston, PA 18704 | 2013-04-12 |
| 1861781403 | Jennifer Ann Richards | Pharmacist | 22 West Side Mall, Edwardsville, PA 18704 | 2011-04-05 |
| 1558512772 | Jolon Theresa Sherin | Speech-Language Pathologist | 1825 Sans Souci Highway, Hanover, PA 18704 | 2008-10-07 |
| 1932361102 | Kari Ann Pietralczyk | Audiologist | 190 Welles Street, Forty-fort, PA 18704 | 2008-06-30 |
| 1467584151 | John Christopher Storti | Chiropractor | 180 United Penn Plaza, Kingston, PA 18704 | 2007-03-09 |
| Find all providers in zip 18704 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285234252 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 220 Madison 2620, Kingston, AR 72742 | 2020-10-29 |
| 1912423468 | Vintage Direct Primary Care | Family Medicine | 25985 Barbr Cutff Rd Ne Ste B1, Kingston, WA 98346-9596 | 2017-08-16 |
| 1063945798 | Danielle Isenburg | Family Medicine | 1240 Ulster Ave Ste 104, Kingston, NY 12401-1517 | 2017-04-10 |
| 1437546140 | Nedal Amin Elass | Family Medicine | 701 Highway 70 E, Kingston, OK 73439-8253 | 2015-04-20 |
| 1790188639 | Lakeside Family Medicine | Family Medicine | 714 Hwy 70 E, Kingston, OK 73439 | 2014-10-07 |
| 1033459680 | Health Quest Medical Practice | Family Medicine | 40 Hurley Ave Ste 18, Kingston, NY 12401-3738 | 2013-02-19 |
| 1295064178 | Lakeside Family Medicine | Family Medicine | 21 N. Main Street, Kingston, OK 73439-1798 | 2009-12-23 |
| 1871769125 | Ira Vohra | Family Medicine | 610 Wyoming Ave Ste 1, Kingston, PA 18704-3702 | 2008-05-07 |
| 1801067145 | Michael E Fath, D.o., P.c | Family Medicine | 618 Wyoming Ave, Kingston, PA 18704-3702 | 2008-03-14 |
| 1275702961 | Baptist Healthcare of Oklahoma | Family Medicine | 700 S Muncrief At Hwy 70, Kingston, OK 73439-0762 | 2008-02-27 |
| Find all providers in KINGSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.