NPIMap

Organization Active NPI

Titusville Area Hospital

Doing business as Conneaut Lake Health Center

  • Rural Health Clinic/Center
  • Conneaut Lake, PA
National Provider Identifier
1053873976
Registry record updated Apr 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TITUSVILLE AREA HOSPITAL
Doing business as
Conneaut Lake Health Center
Practice address
10926 State Highway 18
Conneaut Lake, PA 16316-3526
Phone
(814) 382-0446
Fax
(814) 382-7386
NPI assigned
Apr 1, 2019
Last updated
Apr 1, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2019

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

Authorized official

Name
Jill Ann Neely
Title
Chief Financial Officer
Phone
(814) 827-1851

Specialties & licenses 1

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

Addresses

Primary practice location

10926 State Highway 18
Conneaut Lake, PA 16316-3526

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 382-0446

Other names 1

  • CONNEAUT LAKE HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190603002047 PA Part B Supplier - Hospital Department(S) 8022907575 Receives reassigned benefits from 44 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cambridge Springs, PA; Conneaut Lake, PA; Conneautville, PA; Meadville, PA; Saegertown, PA
O20190613003018 PA Part A Provider - Rural Health Clinic 8022907575 Practice locations: Conneaut Lake, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053873976. Details of each certification follow.

Rural health clinic certification: CCN 393431

Legal name
TITUSVILLE AREA HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2016
Last certification
Jan 5, 2023
Ownership / control type
2B
Most recent change of ownership
Jun 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1984 in PA
Enrollment address
10926 State Highway 18
Conneaut Lake, PA 16316-3526
Related CCNs
391314

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jill a Neely Individual Corporate OfficerChief Financial Officer Jun 1, 2019
W-2 Managing EmployeeChief Financial Officer Jun 1, 2019
Cory F Jackson Individual W-2 Managing EmployeeController Jun 1, 2019
Renato Suntay Individual Corporate OfficerCfo Jun 1, 2019
Operational/Managerial ControlCfo Jun 1, 2019

Change-of-ownership history 1

DateEventCounterparty
Jun 1, 2019 Change of OwnershipThis provider was the buyer Meadville Medical CenterCCN 393431, PA, NPI 1467843771

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554076800000",
    "number": "1053873976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-382-0446",
            "fax_number": "814-382-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 STATE HIGHWAY 18",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163526",
            "telephone_number": "814-382-0446",
            "fax_number": "814-382-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TITUSVILLE AREA HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-01",
        "last_updated": "2019-04-01",
        "status": "A",
        "authorized_official_last_name": "NEELY",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "814-827-1851"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CONNEAUT LAKE HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conneaut Lake, PA

Sources for this page

Verify at the official NPI Registry.