NPIMap

Organization Active NPI

Upmc Community Medicine Inc

  • Family Medicine Physician
  • Conneaut Lake, PA
National Provider Identifier
1003228172
Registry record updated May 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UPMC COMMUNITY MEDICINE INC
Practice address
11065 State Highway 18
Suite 1
Conneaut Lake, PA 16316-3569
Phone
(814) 382-6550
NPI assigned
May 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2014

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

Authorized official

Name
Mark Ehalt
Title
Sr.Director
Phone
(412) 647-0943

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11065 State Highway 18
Suite 1
Conneaut Lake, PA 16316-3569

Mailing address

11065 State Highway 18
Suite 1
Conneaut Lake, PA 16316-3569
Phone (814) 382-6550

Other names 1

  • LAKESIDE FAMILY MEDICINE-UPMC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040217000388 PA Part B Supplier - Clinic/Group Practice 2062318975 Receives reassigned benefits from 1,494 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

11065 State Highway 18
Ste 1
Conneaut Lake, PA 16316
Phone (814) 382-6550

90 Shenango St
Ste 5
Greenville, PA 16125
Phone (440) 293-5555

16039 Conneaut Lake Rd
Ste 106
Meadville, PA 16335
Phone (814) 382-6550

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400803200000",
    "number": "1003228172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11065 STATE HIGHWAY 18",
            "address_2": "SUITE 1",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163569",
            "telephone_number": "814-382-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11065 STATE HIGHWAY 18",
            "address_2": "SUITE 1",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163569",
            "telephone_number": "814-382-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC COMMUNITY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2014-05-23",
        "status": "A",
        "authorized_official_last_name": "EHALT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SR.DIRECTOR",
        "authorized_official_telephone_number": "412-647-0943"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKESIDE FAMILY MEDICINE-UPMC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Conneaut Lake, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.