NPIMap

Organization Active NPI

Orchard Valley Physician Services PLLC

  • Rural Health Clinic/Center
  • New Paris, PA
National Provider Identifier
1083377345
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ORCHARD VALLEY PHYSICIAN SERVICES PLLC
Practice address
4186 Cortland Dr
New Paris, PA 15554-7706
Phone
(814) 839-4108
Fax
(814) 839-4845
NPI assigned
Oct 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Authorized official

Name
Matthew W Hillegass, MDNPI 1346691813
Title
Owner
Phone
(814) 839-4108

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

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

Addresses

Primary practice location

4186 Cortland Dr
New Paris, PA 15554-7706

Mailing address

4186 Cortland Dr
New Paris, PA 15554-7706
Phone (814) 839-4108

Other names 1

  • New Paris Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220830003754 PA Part A Provider - Rural Health Clinic 4385028034 Practice locations: New Paris, PA
O20230222002758 PA Part B Supplier - Clinic/Group Practice 4385028034 Receives reassigned benefits from 10 practitioners
Practice locations: New Paris, PA

Rural health clinic certification: CCN 393901

Legal name
ORCHARD VALLEY PHYSICIAN SERVICES PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2007
Last certification
Jan 19, 2024
Ownership / control type
1B
Most recent change of ownership
Jun 1, 2016 (2 total)
Organization structure
LLCProprietary
Incorporated
Jan 1, 2022 in PA
Enrollment address
4186 Cortland Drive
New Paris, PA 15554-7706

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
39D0180553Orchard Valley Physician Services, PLLC4186 Cortland Dr. Rd 1, New Paris, PA 15554Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Evangeline Hillegass Individual Corporate OfficerCoo Jan 1, 2022
W-2 Managing EmployeeCoo Jan 1, 2022
Matthew Wayne Hillegass Individual 5% Or Greater Direct Ownership Interest Jan 1, 2022 50%
Corporate OfficerCeo Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022

Owners & managing parties with NPI records 2

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2022 Change of OwnershipThis provider was the buyer New Paris Rural Health ClinicCCN 393901, PA, NPI 1588022669

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1083377345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4186 CORTLAND DR",
            "city": "NEW PARIS",
            "state": "PA",
            "postal_code": "155547706",
            "telephone_number": "814-839-4108",
            "fax_number": "814-839-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4186 CORTLAND DR",
            "city": "NEW PARIS",
            "state": "PA",
            "postal_code": "155547706",
            "telephone_number": "814-839-4108",
            "fax_number": "814-839-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORCHARD VALLEY PHYSICIAN SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "HILLEGASS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-839-4108",
        "authorized_official_credential": "MD"
    },
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Paris Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Paris, PA

Sources for this page

Verify at the official NPI Registry.