NPIMap

Organization Active NPI

Olean General Hospital

Doing business as The Pavilion at BRMC

  • Skilled Nursing Facility
  • Bradford, PA
National Provider Identifier
1124014691
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
024702 Issued in PA
Legal business name
OLEAN GENERAL HOSPITAL
Doing business as
The Pavilion at BRMC
Practice address
200 Pleasant Street
Bradford, PA 16701
Phone
(814) 362-8599
Fax
(814) 363-5110
NPI assigned
Sep 21, 2005
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OLEAN GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Jill M. Owens, MD
Title
Ceo
Phone
(716) 373-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 024702 PA Primary

Addresses

Primary practice location

200 Pleasant Street
Bradford, PA 16701

Mailing address

200 Pleasant Street
Bradford, PA 16701
Phone (814) 362-8293

Other identifiers 2

IdentifierTypeStateIssuer
0517OtherPAHIGH MARK BLUE CROSS
1007507650046MedicaidPA

Other names 1

  • The Pavilion at BRMC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180116001206 PA Part A Provider - Skilled Nursing Facility 9133111784 Practice locations: Bradford, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124014691. Details of each certification follow.

Skilled nursing facility certification: CCN 395355

Legal name
OLEAN GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1976
Last certification
Dec 6, 2024
Beds
95
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1898 in NY
Enrollment address
200 Pleasant St
Bradford, PA 16701-1065
Nursing home name
PAVILION AT BRMC, THE

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pavilion at BRMC, theCCN 395355 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9550.6 residents per day on average
Penalties (3 years)
2Fines totaling $16,316

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Rebecca Scheiterle MD17 organizations share this tax ID, including this one
Part of
Rebecca Scheiterle MD

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
David Prince Individual Corporate DirectorBoard Member Sep 1, 2009
Lisa Fiorentino Individual Corporate DirectorBoard Member Jan 1, 2017
Julie Marasco Individual Corporate DirectorBoard Member Jan 1, 2017
David Ferguson Individual Corporate Director Jan 1, 2022
Upper Allegheny Health System Organization, Olean, NY Non-profit Operational/Managerial Control Jan 19, 2008
Melissa Scholl Individual Corporate DirectorBoard Member Jan 1, 2017
Daniel Derose Individual Corporate Director Jan 1, 2022
Douglas Pisano Individual Corporate Director Jan 1, 2022
Anil Pradhan Individual Corporate Director Jan 1, 2022
Cheryl a Klass Individual Corporate OfficerInterim Ceo Sep 4, 2024
Katie Jean Kaus O'Connell Individual Corporate OfficerVP Revenue Cycle Jun 1, 2022
Operational/Managerial ControlVP Revenue Cycle Jun 1, 2022
Jeffrey C Belt Individual Corporate DirectorBoard Member Jan 1, 2017
Muhammed Javed Individual Corporate DirectorVP of Board Nov 5, 2009
Jeannine Schoenecker Individual Corporate DirectorBoard Member Jan 1, 2017
Gilbert Witte Individual Corporate Director Jan 1, 2022
Paul Ridley Individual Corporate DirectorTreasurer Jan 1, 2022
Marc Boutillette Individual Corporate Director Jan 1, 2022

Owners & managing parties with NPI records 3

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1124014691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PLEASANT STREET",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "16701",
            "telephone_number": "814-362-8293",
            "fax_number": "814-363-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PLEASANT STREET",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "16701",
            "telephone_number": "814-362-8599",
            "fax_number": "814-363-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLEAN GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OLEAN GENERAL HOSPITAL",
        "enumeration_date": "2005-09-21",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "716-373-2600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "024702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGH MARK BLUE CROSS",
            "identifier": "0517",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007507650046",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion at BRMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bradford, PA

Sources for this page

Verify at the official NPI Registry.