NPIMap

Organization Active NPI

Mount Nittany Medical Center

Doing business as Mount Nittany Pain Center

  • Pain Clinic/Center
  • State College, PA
National Provider Identifier
1104991801
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
License
550301 Issued in PA
Legal business name
MOUNT NITTANY MEDICAL CENTER
Doing business as
Mount Nittany Pain Center
Practice address
1700 Old Gatesburg Rd Ste 100
State College, PA 16803-2276
Phone
(814) 237-3360
Fax
(814) 231-7098
NPI assigned
Nov 21, 2006
Last updated
May 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
Bryan Roach
Title
Cfo
Phone
(814) 234-6148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X 550301 PA Primary

Addresses

Primary practice location

1700 Old Gatesburg Rd Ste 100
State College, PA 16803-2276

Mailing address

155 Wellness Way
State College, PA 16803-6702
Phone (814) 234-6181

Other names 1

  • Mount Nittany Pain Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000355 PA Part A Provider - Hospital 2365353364 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: State College, PA; Spring Mills, PA; Reedsville, PA; Bellefonte, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104991801. Details of each certification follow.

Hospital certification: CCN 390268

Legal name
MOUNT NITTANY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1979
Last certification
Mar 15, 2017
Beds
260 (231 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 31, 1902 in PA
Enrollment address
155 Wellness Way
State College, PA 16803-6702
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mount Nittany Medical CenterCCN 390268 · All quality measures
Overall star rating
5 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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Barry R Stein Individual Corporate DirectorBoard Member Jan 1, 2015
Kathleen L Rhine Individual Corporate OfficerPresident and Ceo Board Member Jan 17, 2022
Corporate DirectorSecretary Treasurer Jan 17, 2022
W-2 Managing EmployeePresident and Ceo Board Member Jan 30, 2017
Jeff W Pro Individual Corporate DirectorBoard Member Jan 17, 2022
Mount Nittany Health System Organization, State College, PA Corporation, Non-profit Other Jan 1, 2015
Bryan Roach Individual Corporate OfficerCfo Dec 9, 2019
Kenneth Pasch Individual Corporate DirectorDirector Board Member Jan 1, 2015
Nancy Silvis Individual Corporate DirectorDirector Board of Trustees Nov 1, 2016
Dustin G Case Individual Corporate DirectorDirector Board of Trustees Nov 1, 2016
Kristie Lynn Kaufman Individual Corporate DirectorChair Board Member,Board of Trus Jan 17, 2022

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

Affiliated clinicians 578

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

View all 578

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1104991801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036702",
            "telephone_number": "814-234-6181",
            "fax_number": "814-238-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 OLD GATESBURG RD STE 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032276",
            "telephone_number": "814-237-3360",
            "fax_number": "814-231-7098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT NITTANY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-234-6148"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "PA",
            "license": "550301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Nittany Pain Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Nittany Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.