NPIMap

Organization Active NPI

Brookville Hospital

  • Family Medicine Physician
  • Marienville, PA
National Provider Identifier
1235465592
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BROOKVILLE HOSPITAL
Practice address
125 Chestnut Street
Marienville, PA 16239
Phone
(814) 927-5609
Fax
(814) 927-5613
NPI assigned
Oct 21, 2009
Last updated
Dec 1, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Authorized official

Name
Ms. Julianne Peer
Title
President
Phone
(814) 849-1461

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X PA
Family Medicine Physician 207Q00000X PA Primary

Addresses

Primary practice location

125 Chestnut Street
Marienville, PA 16239

Mailing address

100 Hospital Rd
Brookville, PA 15825-1367
Phone (814) 927-5609

Other names 1

  • Marienville Family Health RHC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130221000082 PA Part A Provider - Rural Health Clinic 3072579598 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marienville, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235465592. Details of each certification follow.

Rural health clinic certification: CCN 393412

Legal name
BROOKVILLE HOSPITAL
Doing business as
PENN HIGHLANDS BROOKVILLE FAMILY PRACTICE MARIENVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 16, 2005
Last certification
Sep 21, 2021
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2013 (3 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 13, 1915 in PA
Enrollment address
125 Chestnut Street
Marienville, PA 16239-0463
Related CCNs
391312

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Cradiology Brookville H15 organizations share this tax ID, including this one
Part of
Penn Highlands Healthcare

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Douglas Winner Individual Corporate OfficerSystem Chief Financial Officer Aug 12, 2024
Jourdan D Strishock Individual W-2 Managing EmployeeCompliance Supervisor Aug 1, 2021
Russell E Cameron Individual Corporate OfficerChief Medical Informatics Officer Jul 1, 2016
Penn Highlands Healthcare, Inc. Organization, Dubois, PA Non-profit Other Jan 1, 2013
Robert W O'Leary Individual Corporate DirectorBoard Member Jul 1, 2021
Trina L Johnson Individual Corporate OfficerChief Medical Officer Oct 21, 2022
Edward Yahner Individual Corporate DirectorBoard Member Jul 1, 2025
Joanne Ryan Individual Corporate DirectorBoard Member Jul 1, 2022
David Lezzer Individual Corporate DirectorBoard Member Jul 1, 2021
James E Devlin Individual Corporate DirectorBoard Member Jul 1, 2022
Carlyn Belczyk Individual Corporate DirectorBoard Member Oct 1, 2021
Samuel Lewis Individual Corporate DirectorBoard Member Feb 1, 2021
Richard L Pfingstler Individual Corporate DirectorBoard Member Jul 1, 2021
Donald E Conrad Individual Corporate DirectorBoard Member Jul 1, 2021
Scott H Foradora Individual Corporate DirectorBoard Member Jul 1, 2020
Mark Norman Individual Corporate OfficerChief Operating Officer Jul 1, 2016
W-2 Managing EmployeeAd; Jul 1, 2016
William H Young Individual Corporate DirectorBoard Member Jul 1, 2021
Mark McGinley Individual Corporate DirectorBoard Member Oct 1, 2021
James B Ryan Individual Corporate DirectorBoard Member Jul 1, 2020
John S Sutika Individual Corporate DirectorBoard Member Jul 1, 2025
Brian S Kline Individual Corporate OfficerVP of Finanace Jul 1, 2024
W-2 Managing EmployeeAd; Jul 1, 2024
Steven M Fontaine Individual Corporate OfficerChief Operating Officer Jul 1, 2016
Julianne Peer Individual Corporate OfficerPresident Jan 1, 2013
Corporate Director Aug 12, 2013
W-2 Managing EmployeePresident Jan 1, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1235465592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD",
            "city": "BROOKVILLE",
            "state": "PA",
            "postal_code": "158251367",
            "telephone_number": "814-927-5609",
            "fax_number": "814-927-5613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CHESTNUT STREET",
            "city": "MARIENVILLE",
            "state": "PA",
            "postal_code": "16239",
            "telephone_number": "814-927-5609",
            "fax_number": "814-927-5613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKVILLE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2009-10-21",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "PEER",
        "authorized_official_first_name": "JULIANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-849-1461",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marienville Family Health RHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marienville, PA

Sources for this page

Verify at the official NPI Registry.