NPIMap

Organization Active NPI

Prodigy Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Johnstown, PA
National Provider Identifier
1043393440
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
MD042825E Issued in PA
Legal business name
PRODIGY DIALYSIS
Practice address
105 Metzler St
Johnstown, PA 15904-3124
Phone
(814) 539-0798
Fax
(814) 536-4751
NPI assigned
Oct 23, 2006
Last updated
Aug 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Authorized official

Name
George Frem, MDNPI 1053315549
Title
Ceo
Phone
(814) 244-9873

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X MD042825E PA Primary

Addresses

Primary practice location

105 Metzler St
Johnstown, PA 15904-3124

Mailing address

105 Metzler St
Johnstown, PA 15904-3124
Phone (814) 262-7560

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061113000048 PA Part A Provider - End-Stage Renal Disease Facility (ESRD) 6002812716 Practice locations: Johnstown, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Prodigy Dialysis RichlandCCN 392738
Overall star rating
2.0 of 5
Ownership
Profit
Certified
May 18, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Other
Dialysis stations
11

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Locations

105 Metzler St
Johnstown, PA 15904
Phone (814) 262-7560

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1043393440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 METZLER ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159043124",
            "telephone_number": "814-262-7560",
            "fax_number": "814-536-4751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 METZLER ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159043124",
            "telephone_number": "814-539-0798",
            "fax_number": "814-536-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "FREM",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-244-9873",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "PA",
            "license": "MD042825E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.