NPIMap

Organization Active NPI

Mount Nittany Medical Center

  • Prosthetic/Orthotic Supplier
  • State College, PA
National Provider Identifier
1235339243
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
MOUNT NITTANY MEDICAL CENTER
Practice address
120 Radnor Rd Ste 100
MNMC - Orthotics
State College, PA 16801-7970
Phone
(814) 231-7125
Fax
(814) 238-4167
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
Bryan Roach
Title
Cfo
Phone
(814) 234-6148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

120 Radnor Rd Ste 100
MNMC - Orthotics
State College, PA 16801-7970

Mailing address

155 Wellness Way
State College, PA 16803-6702
Phone (814) 231-7868

Other identifiers 1

IdentifierTypeStateIssuer
100746655 0020MedicaidPA

Other names 1

  • Mount Nittany Medical Center Orthotics Supplier Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930096634 PA DME Supplier - Orthotic Personnel 2365353364 Practice locations: State College, PA

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mount Nittany Medical Center120 Radnor Rd, State College, PA 16801-7970(814) 231-7011 Diabetic Shoes and Inserts Accepts assignmentParticipating since Mar 1, 2006

National Provider Directory

National Provider Directory
Tax ID family
Card Centre Comm Hosp21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

120 Radnor Rd
State College, PA 16801
Phone (814) 231-7128

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1235339243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036702",
            "telephone_number": "814-231-7868",
            "fax_number": "814-231-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RADNOR RD STE 100",
            "address_2": "MNMC - ORTHOTICS",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017970",
            "telephone_number": "814-231-7125",
            "fax_number": "814-238-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT NITTANY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-234-6148"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100746655 0020",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Nittany Medical Center Orthotics Supplier",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Nittany Medical Center Orthotics Supplier",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.