NPIMap

Organization Active NPI

Pinnacle Health Medical Services

Doing business as UPMC Blue Mountain Primary Care

  • Family Medicine Physician
  • Harrisburg, PA
National Provider Identifier
1063850774
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PINNACLE HEALTH MEDICAL SERVICES
Doing business as
UPMC Blue Mountain Primary Care
Practice address
2808 Old Post Rd Ste 104
Harrisburg, PA 17110-3685
Phone
(717) 545-4786
Fax
(717) 545-6359
NPI assigned
Jun 5, 2013
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Amy Wilkinson
Title
Pe Manager
Phone
(717) 231-8038

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

2808 Old Post Rd Ste 104
Harrisburg, PA 17110-3685

Mailing address

409 S 2ND St
Suite 2F
Harrisburg, PA 17104-1612

Other identifiers 1

IdentifierTypeStateIssuer
10076667600064MedicaidPA

Other names 2

  • UPMC Blue Mountain Primary Care Doing business as
  • Blue Mountain Family Practice Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407000180 PA Part B Supplier - Clinic/Group Practice 7618960493 Receives reassigned benefits from 2,171 practitioners
This NPI is an additional NPI on the enrollment

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
39D2112838Upmc Blue Mountain Primary Care2808 Old Post Road, Suite 104, Harrisburg, PA 17110Provider-performed microscopyMay 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Todd R Fisher190 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

425 Westminster Ave
Ste A3
Hanover, PA 17331
Phone (717) 231-8929

Practitioners & affiliated clinicians

Practitioners 11

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": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1063850774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S 2ND ST",
            "address_2": "SUITE 2F",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 OLD POST RD STE 104",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171103685",
            "telephone_number": "717-545-4786",
            "fax_number": "717-545-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE HEALTH MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PE MANAGER",
        "authorized_official_telephone_number": "717-231-8038"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10076667600064",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPMC Blue Mountain Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Mountain Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; 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.