NPIMap

Organization Active NPI

John E Balmer Jr., DO

  • Rural Health Clinic/Center
  • Union City, PA
National Provider Identifier
1073672341
Registry record updated Dec 20, 2019
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Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JOHN E BALMER JR., DO
Practice address
35255 Brown Hill Rd
Union City, PA 16438
Phone
(814) 694-2339
Fax
(814) 694-2176
NPI assigned
Dec 6, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Patricia M Balmer, RN
Title
Office Manager
Phone
(814) 654-7334

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 1

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

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Rural health clinic certification: CCN 393873

Legal name
JOHN E BALMER JR. DO
Doing business as
CANADOHTA LAKE HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 15, 2000
Last certification
Dec 18, 2025
Ownership / control type
1A
Organization structure
Sole ProprietorProprietary
Enrollment address
35255 Brown Hill Rd
Canadohta Lake Health Center
Union City, PA 16438-2919

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030530000062 PA Part A Provider - Rural Health Clinic 9133039407 Practice locations: Union City, PA

All disclosed owners & managing parties 2

Medicare enrollment files

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

NameRoleSinceShare
Patricia Balmer Individual W-2 Managing EmployeeOffice Manager Mar 1, 2002
John E Balmer Individual 5% Or Greater Direct Ownership Interest Oct 1, 1993 100%
Corporate OfficerOwner Oct 1, 1993 100%

National Provider Directory

National Provider Directory
Tax ID family
Canadohta Lake Health Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

35255 Brown Hill Rd
Union City, PA 16438
Phone (814) 694-2339

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

35255 Brown Hill Rd
Union City, PA 16438

Mailing address

PO Box 211
Spartansburg, PA 16434
Phone (814) 654-7334

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
001511070MedicaidPA
870298OtherPABLUE SHIELD

Other names 1

NPPES NPI Registry
  • Canadohta Lake Health Center Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 20, 2019.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1073672341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211",
            "city": "SPARTANSBURG",
            "state": "PA",
            "postal_code": "16434",
            "telephone_number": "814-654-7334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35255 BROWN HILL RD",
            "city": "UNION CITY",
            "state": "PA",
            "postal_code": "16438",
            "telephone_number": "814-694-2339",
            "fax_number": "814-694-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN E BALMER JR., DO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "BALMER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "814-654-7334",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001511070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "870298",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canadohta Lake Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Canadohta Lake Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Union City, PA

Sources for this page

Verify at the official NPI Registry.