Excela Health Physician Practices, Inc.
Organization Active NPI Occupational Medicine Physician · North Huntingdon, PA
NPI 1063877009 · NPPES record last updated Dec 17, 2015
Key facts
- NPI
- 1063877009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Occupational Medicine Physician 2083X0100X
- Legal business name
- EXCELA HEALTH PHYSICIAN PRACTICES, INC.
- Practice address
- 8775 Norwin Ave
North Huntingdon, PA 15642-2718 - Phone
- (724) 765-1230
- NPI assigned
- Dec 17, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- EXCELA HEALTH HOLDING COMPANY
Authorized official
- Name
- Melissa L Dishong
- Title
- Vice President/Executive Director
- Phone
- (724) 830-8500
Corporate family (same tax ID) 41
Practitioners 7
-
Khalil Boussi, MD
-
Jessica R Brock, PT
-
Julie W Hicks, DO
-
Jason Thomas, PA
-
Lorenzo A. Bucci, MD
-
Deep Trivedi, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322001393 | PA | Part B Supplier - Clinic/Group Practice | 6204737117 |
Receives reassigned benefits from 767 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Excela Health Connellsville Internal Med-Dr Tiberio
Locations
1 Mellon Way
Latrobe, PA 15650
Phone (724) 537-1207
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician |
2083X0100X | Yes |
Addresses
Primary practice location
8775 Norwin Ave
North Huntingdon, PA 15642-2718
Mailing address
134 Industrial Park Rd
Ste 2300a
Greensburg, PA 15601-7328
Phone (724) 689-1810
Other names
- Excela Health WORKS
Other providers in North Huntingdon, PA
- East Suburban Pediatric Associates, LTD
- Christie Edwards
- Enlightening Hope Counseling, LLC
- Amanda Evans
- Evernorth Direct Health LLC
- Excela Health Physician Practices, Inc.
- Excela Health Physician Practices, Inc.
- Excela Health Physician Practices, Inc.
- Excela Health Physician Practices, Inc.
- Excela Health Physician Practices, Inc.
All providers in North Huntingdon, PA · Occupational Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.