Penn State Hershey Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2287I501 Issued in PA

Legal business name

PENN STATE HERSHEY ENDOSCOPY CENTER LLC

Practice address

32 Colonnade Way
State College, PA 16803-2309

Phone

(814) 272-4481

Fax

(814) 272-4470

NPI assigned

Dec 21, 2010

Last updated

Sep 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joel Haight, MDNPI 1104895945

Title

Medical Director

Phone

(814) 272-4481

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Penn State Hershey Endoscopy Center LLCCCN 39C0001291

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• The Milton S. Hershey Medical Center

  dba Outpatient Pharmacy

  • Clinic Pharmacy
  • Hershey, PA
  • NPI 1417094624

  Member Of

  NPD member
• The Pennsylvania State University

  dba Psychological Clinic

  • Public Health or Welfare Agency
  • University Park, PA
  • NPI 1386784593

  Member Of

  NPD member

Practitioners 1

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.

• Joel B Haight, M.D.

  • Gastroenterology Physician
  • State College, PA
  • NPI 1104895945
  Authorized official Same address or phone

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1073816690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 COLONNADE WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032309",
            "telephone_number": "814-272-4481",
            "fax_number": "814-272-4470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 COLONNADE WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032309",
            "telephone_number": "814-272-4481",
            "fax_number": "814-272-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN STATE HERSHEY ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-21",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "HAIGHT",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "814-272-4481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "2287I501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CCN",
            "identifier": "39C0001291",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kip M. Peeler, PA-C
• Christopher Pelchar Jr., PHARM D.
• Pelka Endodontics, LLC
• Jakub Pelka, D.M.D.
• Ashli Brooke Pellegrino, PHD
• Pennsylvania CVS Pharmacy LLC (CVS Pharmacy #16632)
• Pennsylvania CVS Pharmacy, L.L.C. (CVS Pharmacy #01916)
• Pennsylvania CVS Pharmacy, L.L.C. (CVS Pharmacy #05459)
• Pennsylvania CVS Pharmacy, L.L.C. (CVS Pharmacy #01688)
• Kevin Michael Peno, PA-C

• Ambulatory Surgical Clinic/Center in State College, PA
• Providers in State College, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.