NPIMap

Individual provider Active NPI

Michael Pennock, MD

  • Radiation Oncology Physician
  • Beaver, PA
National Provider Identifier
1154825057
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
MD484504 Issued in PA
Practice address
1000 Dutch Ridge Rd
Beaver, PA 15009-9727
Phone
(724) 773-7616
Fax
(724) 773-4673
NPI assigned
Mar 23, 2018
Last updated
Jun 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X MD484504 PA Primary

Addresses

Primary practice location

1000 Dutch Ridge Rd
Beaver, PA 15009-9727

Mailing address

1000 Dutch Ridge Rd
Beaver, PA 15009-9727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240709003663 PA Practitioner - Radiation Oncology 7315287125 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Pennsylvania State University College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upmc/HVHS Cancer CenterGroup PAC ID 8224022181, 5 clinicians

Practice addresses (Care Compare)

1000 Dutch Ridge Rd
Beaver, PA 15009-9727
Phone (724) 773-7616

2200 Memorial Dr
Farrell, PA 16121-1357
Phone (724) 983-7570

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD484504PAMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upmc/HVHS Cancer Center CurrentSince Aug 1, 2024 Accepting new patients
University of Pittsburgh Cancer Institute Cancer Services Radiation Oncology CurrentSince Aug 1, 2024 Accepting new patients
Upmc/HVHS Cancer Center Radiation Oncology CurrentSince Aug 1, 2024 Accepting new patients
University of Pittsburgh Cancer Institute Cancer Services CurrentSince Aug 1, 2024 Accepting new patients

Locations

1000 Dutch Ridge Rd
Beaver, PA 15009
Phone (724) 728-7000

22681 Route 68
Clarion, PA 16214
Phone (814) 227-1221

2200 Memorial Dr
Farrell, PA 16121
Phone (724) 981-3500

1600 Coraopolis Heights Rd
Moon Twp, PA 15108
Phone (412) 269-7062

2 Hot Metal St
#One
Pittsburgh, PA 15203
Phone (412) 432-5864

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1154825057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 DUTCH RIDGE RD",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150099727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 DUTCH RIDGE RD",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150099727",
            "telephone_number": "724-773-7616",
            "fax_number": "724-773-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNOCK",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-23",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "PA",
            "license": "MD484504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver, PA

Sources for this page

Verify at the official NPI Registry.