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LACKAWANNA MEDICAL GROUP PC
NPI 1770650962
Internal Medicine in Scranton, PA

Active since November 30, 2006CLIA 39D0927570 · Waiver
201 SMALLACOMBE DR, SCRANTON, PA 18508(570) 961-0171(570) 207-2411 Get Directions Write a Review

NPPES record last updated: March 3, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Lackawanna Medical Group Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LACKAWANNA MEDICAL GROUP PC (NPI 1770650962) is a healthcare organization registered as an internal medicine in Scranton, Pennsylvania and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through April 22, 2027 and lists Charles Thomas Grad, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1770650962
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameLACKAWANNA MEDICAL GROUP PC
Location Address201 SMALLACOMBE DRScranton, PA 18508-2616
Mailing Address201 Smallacombe DrScranton, PA 18508-2616 · (570) 961-0171 · Fax (570) 207-2411
Phone(570) 961-0171
Fax(570) 207-2411
Organization SubpartNo
Authorized OfficialCharles Thomas GradBusiness Manager · (570) 348-1130
Enumeration DateNovember 30, 2006
Last NPPES UpdateMarch 3, 2016
✔ NPI 1770650962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 8

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedNuclear Medicine · Nuclear CardiologyTaxonomy 207UN0901X
Also ListedPediatricsTaxonomy 208000000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
201 SMALLACOMBE DR, Scranton, PA 18508
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Other Identifiers 3

Medicare ID-Type Unspecified039284
Medicare ID-Type Unspecified536244
Medicaid000676727PA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lackawanna Medical Group Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Lackawanna Medical Group PC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Theresa Germano
Nurse Practitioner
NPI 1740839273
201 SMALLACOMBE DR
Scranton, PA 18508
(570) 961-0171
✔ PECOS✔ Accepts Medicare0.2 mi
Emma Rubin, M.D.
Internal Medicine
NPI 1902965924
201 SMALLACOMBE DR
Scranton, PA 18508
(570) 961-0171
✔ PECOS✔ Accepts Medicare0.2 mi
Charles Grad, MD
Gastroenterology
NPI 1093723322
201 SMALLACOMBE DR
Scranton, PA 18508
(570) 961-0171
✔ PECOS✔ Accepts Medicare0.2 mi
Eugene Harasym, M.D.
Family Practice
NPI 1144267790
921 DRINKER TPKE
Covington Township, PA 18444
(570) 842-0945
✔ PECOS12 mi
Carolina Walker, CRNP
Nurse Practitioner
NPI 1700354537
600 PLAZA CT STE C
East Stroudsburg, PA 18301
(570) 517-3772
✔ PECOS✔ Accepts Medicare41 mi
Frank Milani, M.D.
Internal Medicine
NPI 1871651695
201 SMALLACOMBE DR
Scranton, PA 18508
(570) 961-0171
✔ PECOS

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D0927570

Lackawanna Medical Group PC · Scranton, PA
Active · expires Apr 22, 2027
CLIA Number39D0927570
Laboratory TypePhysician Office
Certificate Effective DateApril 23, 2025
Certificate Expiration DateApril 22, 2027
Laboratory DirectorDr. Charles T. Grad
Laboratory Phone(570) 961-0171
Laboratory LocationLackawanna Medical Group PC201 Smallacombe Drive Suite 100, Scranton, PA 18508
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lackawanna Medical Group PC's NPI number?

The NPI number for Lackawanna Medical Group PC is 1770650962. It was assigned to this organization in the NPPES registry on November 30, 2006.

Where is Lackawanna Medical Group PC located?

Lackawanna Medical Group PC is located at 201 Smallacombe Dr, Scranton, PA 18508. The listed phone number is (570) 961-0171.

What is Lackawanna Medical Group PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Lackawanna Medical Group PC enrolled in Medicare?

Yes. Lackawanna Medical Group PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lackawanna Medical Group PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians reassign their Medicare billing to Lackawanna Medical Group PC, in Family Practice, Gastroenterology, Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lackawanna Medical Group PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D0927570) is associated with this NPI, valid through April 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lackawanna Medical Group PC was last updated on March 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.