CARBONDALE PEDIATRIC CENTER
NPI 1336416619
Pediatrics in Carbondale, PA

NPI Status: Active since November 30, 2011

Contact Information

152 BROOKLYN ST
CARBONDALE, PA
ZIP 18407
Phone: (570) 282-2031
Fax: (570) 282-2534

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  • Organization
  • Pediatrics
  • CLIA Number: 39D2303567
  • CLIA Cert. Type: Federally Qualified Health Center
  • CLIA Exp. Date: 04-25-2026

About CARBONDALE PEDIATRIC CENTER

This page provides the complete NPI Profile along with additional information for Carbondale Pediatric Center, a pediatrician established in Carbondale, Pennsylvania operating as a Pediatrics. The healthcare provider is registered in the NPI registry with number 1336416619 assigned on November 2011. The practitioner's primary taxonomy code is 208000000X. The provider is registered as an organization and their NPI record was last updated 15 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Carbondale Pediatric Center. The authorized official of this NPI record is Frederick Jackson (Executive Director)

NPI
1336416619
Provider Legal Name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Other Organization Name
CARBONDALE PEDIATRIC CENTER
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
152 BROOKLYN ST CARBONDALE, PA 18407
Location Phone
(570) 282-2031
Location Fax
(570) 282-2534
Mailing Address
601 PARK ST HONESDALE, PA 18431
Mailing Phone
(570) 253-8226
Mailing Fax
(570) 282-2534
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-30-2011
Last Update Date
11-30-2011
Code Navigator

A pediatrician like Carbondale Pediatric Center is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Pediatrics

Taxonomy Code
208000000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

FREDERICK JACKSON

Authorized Official Title
EXECUTIVE DIRECTOR
Authorized Official Phone
(570) 253-8450

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
100773665MEDICAID (05)PA 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
39D2303567
Facility Type
Federally Qualified Health Center
Certificate Effective Date
April 26, 2024
Certificate Expiration Date
April 25, 2026
Laboratory Director
DR. STANLEY R. SKONIECZKI III
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Carbondale Pediatric Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1336416619, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
3
Unchanged
Pos 3
3
Doubled → 6
Pos 4
6
Unchanged
Pos 5
4
Doubled → 8
Pos 6
1
Unchanged
Pos 7
6
Doubled → 12 → 1 + 2
Pos 8
6
Unchanged
Pos 9
1
Doubled → 2
Check
9
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 3 → 6 4 → 8 6 → 12 → 3 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 3 + 6 + 6 + 8 + 1 + 1 + 2 + 6 + 2 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9
This NPI is valid
The calculated check digit is 9, which matches the last digit of 1336416619.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1336416619, enumerated as an "organization" on November 30, 2011.

The provider is located at 152 BROOKLYN ST CARBONDALE, PA 18407 and the phone number is (570) 282-2031.

Pediatrics with taxonomy code 208000000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.