Indiana Regional Medical Center
Organization Active NPI Internal Medicine Physician · Blairsville, PA
NPI 1104055946 · NPPES record last updated Jul 10, 2024
Key facts
- NPI
- 1104055946
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 090701 (PA)
- Legal business name
- INDIANA REGIONAL MEDICAL CENTER
- Practice address
- Indiana at Chestnut Ridge
25 Colony Blvd
Blairsville, PA 15717 - Phone
- (724) 357-7009
- Fax
- (724) 357-7414
- NPI assigned
- Jul 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael F Ickowski, CPA, MBA
- Title
- Chief Financial Officer
- Phone
- (724) 357-7008
Owners & managing parties with NPI records 5
-
Russell Drozdiak, M.D.
-
Kyle A Lingenfelter, MD FACS
-
Richard K Neff, MD
-
Chad R Shaffer, MD
Other NPIs on the same Medicare enrollment 3
Related certifications (CCN) 5
Affiliated clinicians 352
-
Stephen Adeyemi, NP
-
Durre Ahmed, MD
-
Jamil Ahmed, MD
-
Waqar Alam, MBBS
-
Shoaib Ali, M.D.
-
Haley May Altemus, PA-C
-
Shirish A Amin, MD
-
Benjamin Ascari, CRNA
-
Kim R Avolio, DO
-
John Baber, DO
-
Stephen H Bailey, MD
-
Imran Mushtaq Bajwa, M.D.
-
Rabia Bajwa, M.D.
-
Samuel C Baroody, DO
-
Arwen E Bassler, MD
-
Noah Joseph Belak, PA-C
-
Rebecca Anne Bell, PA-C
-
Christine Bender, PA-C
Medicare Care Compare: Hospital
- Listed as
- Indiana Regional Medical Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Hospital certification: CCN 390173
- Legal name
- INDIANA REGIONAL MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Mar 12, 2021
- Beds
- 166
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 16, 1913 in PA
- Enrollment address
- 145 Irmc Dr
Indiana, PA 15701-3673 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 26
| Name | Role | Since | Share |
|---|---|---|---|
| James R Martin |
Corporate Director |
Nov 1, 2020 | |
| Christina Lubold |
Corporate Director |
Jan 1, 2022 | |
| Mary Krauland |
Corporate Director |
Jul 1, 2024 | |
| James Kinneer |
W-2 Managing Employee |
Nov 28, 2017 | 14.28% |
| Nathan Kovalchick |
Corporate Officer |
Jan 1, 2022 | |
| Wendell S Davis |
Corporate Director |
Jul 1, 2024 | |
| Pennsylvania Mountains Care Network |
5% Or Greater Direct Ownership Interest | Nov 1, 2020 | 100% |
| Operational/Managerial Control | Nov 1, 2020 | 100% | |
| Laurie Kuzneski |
Corporate Director |
Jan 1, 2020 | |
| Michael F Ickowski Sr |
W-2 Managing Employee |
Jun 26, 2023 | 14.28% |
| Mark Richards |
W-2 Managing Employee |
Nov 28, 2017 | 14.28% |
| Operational/Managerial Control |
Nov 28, 2017 | 5% | |
| April L Miller |
W-2 Managing Employee |
Apr 8, 2024 | |
| Sandra Luttner |
Operational/Managerial Control |
Nov 2, 2009 | |
| T Clark Simpson |
Corporate Director |
Nov 1, 2020 | |
| Frank Roberts |
Corporate Officer |
Nov 1, 2020 | |
| Todd Brice |
Corporate Director |
Nov 1, 2020 | |
| Mark Volovic |
W-2 Managing Employee |
May 1, 2017 | 14.28% |
| Rebecca Stapleton |
Corporate Director |
Nov 1, 2017 | 5% |
| Wendy Haislip |
W-2 Managing Employee |
Oct 21, 2019 | 14.28% |
| Richard K Neff |
W-2 Managing Employee |
Oct 26, 2020 | 14.28% |
| Chad R Shaffer |
Corporate Director |
Jul 1, 2024 | |
| Hilliary Creely |
Corporate Director |
Nov 1, 2020 | |
| Stephen a Wolfe |
Corporate Director |
Feb 11, 1999 | |
| W-2 Managing Employee |
Feb 11, 1999 | 14.28% | |
| Kyle a Lingenfelter |
Corporate Director |
Jan 1, 2026 | |
| T Michael Price |
Corporate Officer |
Nov 1, 2020 | |
| Russell a Drozdiak |
Corporate Director |
Nov 1, 2020 | |
| David Reed |
Corporate Director |
Jan 1, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081216000245 | PA | Part a Provider - Hospital | 6800791187 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Indiana, PA; Seward, PA; Northern Cambria, PA; Marion Center, PA; Ligonier, PA; Greensburg, PA; Blairsville, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 090701 | PA | Yes |
| Urgent Care Clinic/Center | 261QU0200X | 090701 | PA |
Addresses
Primary practice location
Indiana at Chestnut Ridge
25 Colony Blvd
Blairsville, PA 15717
Mailing address
PO Box 788
835 Hospital Road
Indiana, PA 15701-0788
Phone (724) 357-7009
Other providers in Blairsville, PA
- Adam Highberger
- Bruce Conrad Highberger
- Amanda Marie Hydock
- Kristy Leigh Ilgen
- Indiana Pediatric Associates, P C a
- Indiana Total Therapy, Inc
- Jaclyn Bridges Jarvie
- Keystone Rehabilitation Systems Inc
- Klain, Heasley, Nettleton MD PC
- Klain, Heasley, Nettleton MD PC
All providers in Blairsville, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.