NPIMap

Organization Active NPI

Millcreek Community Hospital

  • Psychiatry Physician
  • Erie, PA
National Provider Identifier
1245865815
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MILLCREEK COMMUNITY HOSPITAL
Practice address
4740 Peach St
Erie, PA 16509-2008
Phone
(814) 454-3174
Fax
(814) 616-8002
NPI assigned
Mar 4, 2020
Organization subpart
Yes
Parent organization
MILLCREEK COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Richard Lusk
Title
Chief Financial Officer
Phone
(814) 868-7760

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

4740 Peach St
Erie, PA 16509-2008

Mailing address

5515 Peach St
Erie, PA 16509-2603
Phone (814) 864-4031

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200617000674 PA Part B Supplier - Hospital Department(S) 8426020173 Receives reassigned benefits from 17 practitioners
Practice locations: Erie, PA

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Millcreek Community Hos34 organizations share this tax ID, including this one
Part of
Millcreek Community Hos

Other organizations with this tax ID 33

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

View all 33

Locations

4740 Peach St
Erie, PA 16509
Phone (814) 454-3174

Practitioners & affiliated clinicians

Practitioners 75

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

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1245865815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5515 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-864-4031",
            "fax_number": "814-868-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092008",
            "telephone_number": "814-454-3174",
            "fax_number": "814-616-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK COMMUNITY HOSPITAL",
        "enumeration_date": "2020-03-04",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "LUSK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "814-868-7760"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 26, 2023; 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.