NPIMap

Organization Active NPI

Upmc Community Medicine, Inc.

  • Non-Pharmacy Dispensing Site
  • Fishertown, PA
National Provider Identifier
1104081785
Registry record updated May 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
OS010738L Issued in PA
Legal business name
UPMC COMMUNITY MEDICINE, INC.
Practice address
2040 Quaker Valley Rd
Fishertown, PA 15539-9723
Phone
(814) 839-4152
NPI assigned
Jul 23, 2008
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2013

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X OS010738L PA Primary

Addresses

Primary practice location

2040 Quaker Valley Rd
Fishertown, PA 15539-9723

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Chestnut Ridge Family Medicine - UPMC Doing business as

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
39D0180528Chestnut Ridge Family Med Upmc2040 Quaker Valley Road, Fishertown, PA 15539Certificate of waiverApr 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
University Family Pract200 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2040 Quaker Valley Rd
Fishertown, PA 15539
Phone (814) 839-4152

NPI Registry JSON

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1104081785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 QUAKER VALLEY RD",
            "city": "FISHERTOWN",
            "state": "PA",
            "postal_code": "155399723",
            "telephone_number": "814-839-4152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC COMMUNITY MEDICINE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-07-23",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "OS010738L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chestnut Ridge Family Medicine - UPMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fishertown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.