NPIMap

Organization Active NPI

Meadville Medical Center

  • Pain Medicine (Anesthesiology) Physician
  • Meadville, PA
National Provider Identifier
1295084044
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
MEADVILLE MEDICAL CENTER
Practice address
1015 Grove St
Meadville, PA 16335-2905
Phone
(814) 373-3472
Fax
(814) 373-7082
NPI assigned
Sep 6, 2012
Last updated
Feb 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Mr. Renato Suntay
Title
Chief Financial Officer
Phone
(814) 333-5030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X Primary

Addresses

Primary practice location

1015 Grove St
Meadville, PA 16335-2905

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 373-3472

Other names 1

  • Meadville Pain Management Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121205000274 PA Part B Supplier - Clinic/Group Practice 4284535790 Receives reassigned benefits from 3 practitioners
Practice locations: Meadville, PA

Other NPIs with the same Medicare PAC ID 20

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

View all 20

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2076031Meadville Pain Management1015 Grove Street, Meadville, PA 16335Certificate of waiverApr 9, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Meadville Medical CenterMeadville, PA, CCN 390113 Hospital Operational/Managerial Control Sep 15, 2008
Titusville Area HospitalTitusville, PA, CCN 391314 Hospital 5% Or Greater Indirect Ownership Interest Oct 1, 2015
Titusville Area HospitalTitusville, PA, CCN 39Z314 Hospital 5% Or Greater Indirect Ownership Interest Oct 1, 2015
Vna AllianceMeadville, PA, CCN 397655 Home health agency 5% Or Greater Direct Ownership Interest (25%) Jun 28, 2023
Titusville Area HospitalTitusville, PA, CCN 393438 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Titusville Area HospitalTitusville, PA, CCN 393442 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Titusville Area HospitalOil City, PA, CCN 393441 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Tionesta Health CenterTionesta, PA, CCN 393449 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1295084044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-373-3472",
            "fax_number": "814-373-7082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352905",
            "telephone_number": "814-373-3472",
            "fax_number": "814-373-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADVILLE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "SUNTAY",
        "authorized_official_first_name": "RENATO",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "814-333-5030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadville Pain Management",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Meadville Pain Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.