NPIMap

Individual provider Active NPI

Jason Ferderber

  • Sports Medicine (Emergency Medicine) Physician
  • State College, PA
National Provider Identifier
1023544053
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X
License
MD467872 Issued in PA
Practice address
1700 Old Gatesburg Rd Ste 200
State College, PA 16803-2276
Phone
(814) 237-4321
Fax
(814) 235-0484
NPI assigned
May 11, 2017
Last updated
Jul 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Emergency Medicine) Physician 207PS0010X MD467872 PA Primary

Addresses

Primary practice location

1700 Old Gatesburg Rd Ste 200
State College, PA 16803-2276

Mailing address

1700 Old Gatesburg Rd Ste 200
State College, PA 16803-2276
Phone (814) 237-4321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191111000116 PA Practitioner - Sports MedicinePractitioner - Emergency Medicine 9830467653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Pennsylvania State University College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1700 Old Gatesburg Rd
Suite 200
State College, PA 16803-2276
Phone (814) 237-4321

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD467872PAMDSports Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Pittsburgh Physicians CurrentSince Oct 1, 2019 Accepting new patients
University of Pittsburgh Physicians CurrentSince Oct 1, 2019 Accepting new patients
Martin & Suhey Orthopedics, P.C. CurrentSince Jul 1, 2021 Accepting new patients
Mount Nittany Medical Center Health Services Inc CurrentSince Jul 1, 2021 Accepting new patients
University of Pittsburgh Physicians Current Accepting new patients
Mount Nittany Medical Center Health Services Inc Past Accepting new patients

Locations

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

200 Lothrop St
Pittsburgh, PA 15213
Phone (412) 647-3553

3600 Forbes Ave
Ste 140
Pittsburgh, PA 15213

164 Greenview Dr
Ste 200
State College, PA 16803
Phone (814) 237-4321

1700 Old Gatesburg Rd
Ste 200
State College, PA 16803
Phone (814) 237-4321

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1023544053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 OLD GATESBURG RD STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032276",
            "telephone_number": "814-237-4321",
            "fax_number": "814-235-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 OLD GATESBURG RD STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032276",
            "telephone_number": "814-237-4321",
            "fax_number": "814-235-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERDERBER",
        "first_name": "JASON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "PA",
            "license": "MD467872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.