NPIMap

Organization Active NPI

JC Blair Memorial Hospital

Doing business as Penn Highlands State College, A Campus of Penn Highlands Huntingdon

  • Pulmonary Disease Physician
  • State College, PA
National Provider Identifier
1093567182
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
JC BLAIR MEMORIAL HOSPITAL
Doing business as
Penn Highlands State College, A Campus of Penn Highlands Huntingdon
Practice address
239 Colonnade Blvd
State College, PA 16803-2668
Phone
(814) 375-3770
NPI assigned
Apr 3, 2024
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Jourdan Strishock
Title
Compliance
Phone
(814) 375-6160

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X NU Primary
Pulmonary Function Technologist 225B00000X NU
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

239 Colonnade Blvd
State College, PA 16803-2668

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-6160

Other names 1

  • Penn Highlands State College, A Campus of Penn Highlands Huntingdon Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040121000045 PA Part B Supplier - Clinic/Group Practice 2668378407 Receives reassigned benefits from 56 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altoona, PA; State College, PA; Huntingdon, PA
O20120405000698 PA Part A Provider - Hospital 2668378407 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altoona, PA; Huntingdon, PA; State College, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093567182. Details of each certification follow.

Hospital certification: CCN 390056

Legal name
J C BLAIR MEMORIAL HOSPITAL
Doing business as
PENN HIGHLANDS HUNTINGDON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 13, 2024
Beds
77
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1909 in PA
Enrollment address
1225 Warm Springs Avenue
Huntingdon, PA 16652-2350
Other Hospital Practice Location
Hospital subgroups
Acute care, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

Care Compare: Hospital

Medicare Care Compare
Listed as
Penn Highlands HuntingdonCCN 390056 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Blair Mem Hosp Lab J31 organizations share this tax ID, including this one
Part of
Penn Highlands Healthcare

Other organizations with this tax ID 30

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

View all 30

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Douglas Winner Individual Corporate OfficerSystem Chief Financial Officer Aug 12, 2024
Jourdan D Strishock Individual W-2 Managing EmployeeCompliance Supervisor Aug 1, 2021
Russell E Cameron Individual Corporate OfficerChief Medical Information Office Jul 1, 2016
Penn Highlands Healthcare, Inc. Organization, Du Bois, PA Non-profit Operational/Managerial Control Jun 1, 2019
Robert W O'Leary Individual Corporate DirectorBoard Member Jul 1, 2021
Trina L Johnson Individual Corporate OfficerChief Medical Officer Oct 21, 2022
Edward Yahner Individual Corporate DirectorBoard Member Jul 1, 2025
Joanne Ryan Individual Corporate DirectorBoard Member Jul 1, 2022
David Lezzer Individual Corporate DirectorBoard Member Jul 1, 2021
James E Devlin Individual Corporate DirectorBoard Member Jul 1, 2022
Carlyn Belczyk Individual Corporate DirectorBoard Member Oct 1, 2021
Samuel Lewis Individual Corporate DirectorBoard Member Feb 1, 2021
Richard L Pfingstler Individual Corporate DirectorBoard Member Jul 1, 2021
Donald E Conrad Individual Corporate DirectorBoard Member Jul 1, 2021
Scott H Foradora Individual Corporate DirectorBoard Member Jul 1, 2020
Mark Norman Individual Corporate OfficerChief Operationg Officer Jul 1, 2016
W-2 Managing EmployeeChief Operating Officer Jul 1, 2016
William H Young Individual Corporate DirectorBoard Member Jul 1, 2021
Mark McGinley Individual Corporate DirectorBoard Member Oct 1, 2021
James B Ryan Individual Corporate DirectorBoard Member Jul 1, 2020
John S Sutika Individual Corporate DirectorDirector Jul 1, 2025
Brian S Kline Individual Corporate OfficerChief Financial Officer Jul 1, 2024
W-2 Managing EmployeeChief Financial Officer Jul 1, 2024
Steven M Fontaine Individual Corporate OfficerChief Executive Officer Jul 1, 2016

Owners & managing parties with NPI records 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

Affiliated clinicians 334

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 334

NPI Registry JSON

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1093567182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-375-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 COLONNADE BLVD",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032668",
            "telephone_number": "814-375-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JC BLAIR MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "STRISHOCK",
        "authorized_official_first_name": "JOURDAN",
        "authorized_official_title_or_position": "COMPLIANCE",
        "authorized_official_telephone_number": "814-375-6160"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225B00000X",
            "taxonomy_group": "",
            "desc": "Pulmonary Function Technologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Highlands State College, A Campus of Penn Highlands Huntingdon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.