Organization Active NPI

Divine Providence Hospital of the Sisters of Christian Charity

Psychiatric Hospital
Williamsport, PA

National Provider Identifier

1104851849

Registry record updated Jul 25, 2016

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Williamsport, PA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Psychiatric HospitalTaxonomy code 283Q00000X
License: 041001 Issued in PA
Legal business name: DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Practice address: 1100 Grampian Blvd
Williamsport, PA 17701-1909
Phone: (570) 326-8000
Fax: (570) 326-8601
NPI assigned: Jul 11, 2006
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Jul 25, 2016

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

Authorized official

Name: Mr. Eric D. Pohjala, FHFMA, FACHE
Title: Executive Vice President Cfo, Cpo
Phone: (570) 321-3171

Specialties & licenses 4

Specialty (taxonomy)	Code	License	State	Primary
Ambulatory Surgical Clinic/Center	261QA1903X	041001	PA
Mammography Clinic/Center	261QR0206X	041001	PA
General Acute Care Hospital	282N00000X	041001	PA
Psychiatric Hospital	283Q00000X	041001	PA	Primary

Addresses

Primary practice location

1100 Grampian Blvd
Williamsport, PA 17701-1909

Mailing address

1205 Grampian Blvd
2ND Floor
Williamsport, PA 17701-1978
Phone (570) 326-8676

Other identifiers 11

Identifier	Type	State	Issuer
20012697	Other	PA	AMERIHEALTH HMO AMER PIN
816867	Other	PA	FIRST PRIORITY HEALTH PIN
000070	Other	PA	AMERIHEALTH ADMINST PIN
394048	Other	PA	HEALTH ASSURANCE PIN
1066310	Other	PA	KEYSTONE MERCY HEALTH PIN
396871	Other	PA	BLACK LUNG PROGRAM PIN
1007563750008	Medicaid	PA
394048	Other	PA	BLUE CROSS PIN
394048	Other	PA	AETNA PIN
70159	Other	PA	GEISINGER HEALTH PLAN PIN
394048	Other	PA	HEALTH AMERICA PIN

Other names 1

Divine Providence Hospital Other name

National Provider Directory

Locations

1205 Grampian Blvd
Fl 2
Williamsport, PA 17701

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1104851849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 GRAMPIAN BLVD",
            "address_2": "2ND FLOOR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011978",
            "telephone_number": "570-326-8676",
            "fax_number": "570-326-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011909",
            "telephone_number": "570-326-8000",
            "fax_number": "570-326-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "POHJALA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT CFO, CPO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FHFMA, FACHE"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "041001",
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "PA",
            "license": "041001",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "041001",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "PA",
            "license": "041001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO AMER PIN",
            "identifier": "20012697",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH PIN",
            "identifier": "816867",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH ADMINST PIN",
            "identifier": "000070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTH PIN",
            "identifier": "1066310",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG PROGRAM PIN",
            "identifier": "396871",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007563750008",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "394048",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN PIN",
            "identifier": "70159",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA PIN",
            "identifier": "394048",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Providence Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.