NPIMap

Organization Active NPI

Upmc Kane

  • Rural Health Clinic/Center
  • Johnsonburg, PA
National Provider Identifier
1043821002
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UPMC KANE
Practice address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone
(814) 389-4412
NPI assigned
Aug 13, 2020
Last updated
Aug 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Mark Papalia
Title
VP Ops
Phone
(814) 837-4514

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

81 Clarion Rd
Johnsonburg, PA 15845-1656

Mailing address

81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone (814) 389-4412

Other names 1

  • Upmc Kane Primary & Specialty Care - Johnsonburg Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201006001588 PA Part A Provider - Rural Health Clinic 7113814625 Practice locations: Johnsonburg, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043821002. Details of each certification follow.

Rural health clinic certification: CCN 393453

Legal name
UPMC KANE
Doing business as
UPMC KANE PRIMARY & SPECIALTY CARE-JOHNSONBURG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2023
Last certification
Dec 21, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1927 in PA
Enrollment address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Related CCNs
390104

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0986134Upmc Kane RHC-Johnsonburg81 Clarion Road, Johnsonburg, PA 15845Certificate of waiverMay 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Hosp Lab4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Francis P Foti Individual Corporate Director Apr 1, 2017
Mark Papalia Individual Corporate OfficerPresident Jun 1, 2018
Operational/Managerial ControlManaging Employee Jun 1, 2018
Upmc Hamot Organization, Erie, PA Corporation, Non-profit Operational/Managerial Control Feb 1, 2001
Ronald Mattis Individual Corporate Director Jul 1, 2002
Carrie Ennis Individual Corporate Director Jan 1, 2018
Linda Myers Individual Corporate Director Jul 1, 2006
David P Gibbons Individual Corporate DirectorChairman Apr 1, 2017
Bradley Dinger Individual Corporate OfficerCfo/Secretary Jul 31, 2018
Operational/Managerial ControlManaging Employee Jul 31, 2018
Erik Ross Individual Corporate DirectorTreasurer Jul 1, 1998
Halcom Bard Individual Corporate Director Feb 18, 2011
Donald Payne Individual Corporate DirectorVice Chairman Jul 1, 1991

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Upmc KaneKane, PA, CCN 39Z318 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Upmc Kane
    • Medicare Defined Swing Bed Hospital Unit
    • Kane, PA
    • NPI 1467635375

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1043821002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 CLARION RD",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451656",
            "telephone_number": "814-389-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 CLARION RD",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451656",
            "telephone_number": "814-389-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC KANE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "PAPALIA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "814-837-4514"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upmc Kane Primary & Specialty Care - Johnsonburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnsonburg, PA

Sources for this page

Verify at the official NPI Registry.