NPIMap

Organization Active NPI

Upmc Bedford Memorial

  • Emergency Medicine Physician
  • Everett, PA
National Provider Identifier
1184772113
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
650501 Issued in PA
Legal business name
UPMC BEDFORD MEMORIAL
Practice address
10455 Lincoln Hwy
Everett, PA 15537-7046
Phone
(814) 623-6161
Fax
(814) 623-3535
NPI assigned
Jan 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Roger Winn
Title
Ceo
Phone
(814) 623-1104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 650501 PA Primary

Addresses

Primary practice location

10455 Lincoln Hwy
Everett, PA 15537-7046

Mailing address

10455 Lincoln Hwy
Everett, PA 15537-7046
Phone (814) 623-6161

Other identifiers 1

IdentifierTypeStateIssuer
1007460470004MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000321 PA Part B Supplier - Clinic/Group Practice 6103811971 Receives reassigned benefits from 127 practitioners
Practice locations: Everett, PA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 127

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 127

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184772113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10455 LINCOLN HWY",
            "city": "EVERETT",
            "state": "PA",
            "postal_code": "155377046",
            "telephone_number": "814-623-6161",
            "fax_number": "814-623-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10455 LINCOLN HWY",
            "city": "EVERETT",
            "state": "PA",
            "postal_code": "155377046",
            "telephone_number": "814-623-6161",
            "fax_number": "814-623-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC BEDFORD MEMORIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WINN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-623-1104",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "650501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007460470004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.