NPIMap

Organization Active NPI

Ear Nose and Throat Specialists of Northwestern Pennsylvania

  • Otolaryngology Physician
  • Erie, PA
National Provider Identifier
1194754846
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
EAR NOSE AND THROAT SPECIALISTS OF NORTHWESTERN PENNSYLVANIA
Practice address
1645 W 8TH St
Suite 200
Erie, PA 16505-5007
Phone
(814) 864-9994
Fax
(814) 866-2655
NPI assigned
Jul 2, 2006
Last updated
Apr 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Authorized official

Name
Mr. Robert M BudackiNPI 1528099843
Title
Practice Administrator
Phone
(814) 864-9994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

1645 W 8TH St
Suite 200
Erie, PA 16505-5007

Mailing address

1645 W 8TH St
Suite 200
Erie, PA 16505-5007
Phone (814) 864-9994

Other identifiers 2

IdentifierTypeStateIssuer
CI4811OtherRAILROAD MEDICARE
01402146MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000112 PA Part B Supplier - Clinic/Group Practice 0648184283 Receives reassigned benefits from 11 practitioners
Practice locations: Erie, PA

National Provider Directory

National Provider Directory

Locations

348 W Main Rd
Conneaut, OH 44030
Phone (440) 593-2804

1645 W 8th St
#200
Erie, PA 16505
Phone (814) 864-9994

1645 W 8th St
Ste 200
Erie, PA 16505
Phone (814) 864-9994

3580 Peach St
Erie, PA 16508
Phone (814) 864-9994

3580 Peach St
Ste 106
Erie, PA 16508
Phone (814) 456-2031

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1194754846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "address_2": "SUITE 200",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-864-9994",
            "fax_number": "814-866-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "address_2": "SUITE 200",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-864-9994",
            "fax_number": "814-866-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE AND THROAT SPECIALISTS OF NORTHWESTERN PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "BUDACKI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "814-864-9994",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI4811",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01402146",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.