NPIMap

Organization Active NPI

Nittany Valley Medical Associates P.C.

  • Specialist
  • State College, PA
National Provider Identifier
1083601249
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NITTANY VALLEY MEDICAL ASSOCIATES P.C.
Practice address
2134 Sandy Dr Ste 16
State College, PA 16803-2292
Phone
(814) 272-5805
Fax
(814) 272-0110
NPI assigned
Oct 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Authorized official

Name
Eileen Clarke
Title
Practice Manager
Phone
(814) 359-6866

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2134 Sandy Dr Ste 16
State College, PA 16803-2292

Mailing address

2134 Sandy Dr Ste 16
State College, PA 16803-2292
Phone (814) 272-5805

Other identifiers 5

IdentifierTypeStateIssuer
1409586OtherPAHIGHMARK BS
0019162000001MedicaidPA
104HOtherPAGEISINGER
50000799OtherPACAPITAL BC/BS
CJ9571OtherPARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041006000020 PA Part B Supplier - Clinic/Group Practice 6002875077 Receives reassigned benefits from 5 practitioners
Practice locations: Belleville, PA; State College, PA

National Provider Directory

National Provider Directory

Locations

7 E Water St
Lock Haven, PA 17745
Phone (570) 748-3690

301 Science Park Rd
Ste 207
State College, PA 16803

301 Science Park Rd
Ste 119
State College, PA 16803

Practitioners & affiliated clinicians

Practitioners 8

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": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1083601249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2134 SANDY DR STE 16",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032292",
            "telephone_number": "814-272-5805",
            "fax_number": "814-272-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2134 SANDY DR STE 16",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032292",
            "telephone_number": "814-272-5805",
            "fax_number": "814-272-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NITTANY VALLEY MEDICAL ASSOCIATES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2021-10-28",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "814-359-6866"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "1409586",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019162000001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "104H",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BC/BS",
            "identifier": "50000799",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ9571",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.