NPIMap

Organization Active NPI

Glade Run Medical Associates

  • Psychologist
  • Kittanning, PA
National Provider Identifier
1134617376
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
GLADE RUN MEDICAL ASSOCIATES
Practice address
1 Nolte Dr
Kittanning, PA 16201-7111
Phone
(724) 543-8500
Fax
(724) 543-8616
NPI assigned
Apr 24, 2018
Last updated
Aug 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Authorized official

Name
Matthew Kociola
Title
Cfo
Phone
(724) 543-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

1 Nolte Dr
Kittanning, PA 16201-7111

Mailing address

1 Nolte Dr
Kittanning, PA 16201-7111
Phone (724) 543-8500

Other names 1

  • Armstrong Behavioral Health Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100806000006 PA Part B Supplier - Clinic/Group Practice 3577696897 Receives reassigned benefits from 40 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kittanning, PA; Sarver, PA; New Bethlehem, PA; Natrona Heights, PA

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory
Tax ID family
Glade Run Medical Assoc Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1134617376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NOLTE DR",
            "city": "KITTANNING",
            "state": "PA",
            "postal_code": "162017111",
            "telephone_number": "724-543-8500",
            "fax_number": "724-543-8616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 NOLTE DR",
            "city": "KITTANNING",
            "state": "PA",
            "postal_code": "162017111",
            "telephone_number": "724-543-8500",
            "fax_number": "724-543-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLADE RUN MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-24",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "KOCIOLA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "724-543-8500"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Armstrong Behavioral Health",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Armstrong Behavioral Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kittanning, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.