Meadville Medical Center
Organization Active NPI Pain Medicine (Anesthesiology) Physician · Meadville, PA
NPI 1295084044 · NPPES record last updated Feb 3, 2020
Key facts
- NPI
- 1295084044
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Renato Suntay
- Title
- Chief Financial Officer
- Phone
- (814) 333-5030
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 20
Practitioners 139
-
Tom Chatham, PA-C
-
Heather M Haskins, P.A.
-
Haibin Wang, MD, PHD
-
Anne-Lise Armstrong, M.D.
-
John H Bailey III, D.O.
-
Sarah Ann Barco, DO
-
Stephen George Basheda, D.O.
-
Kathleen S. Berkey, M.A., M.S.
-
Kelly Kae Bidwell, LCSW
-
Samantha N Black, CRNP
-
Jason W Brown, M.D.
-
Barbara Ann Bruns, AUD
-
Mela Louise Calomino, MSW,LSW
-
Kenneth Challener, M.D.
-
Kimberly M Chess, CRNP
-
Amie S Coffman, D.O.
-
Janice Lynn D'Ambrosi, CRNP
-
Pamela Rae Dailey, LCSW
-
Judd Walter Dawson, D.O.
-
David M Dechellis, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2076031 | Meadville Pain Management | Certificate of waiver | Apr 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Meadville Medical Center |
Hospital | Operational/Managerial Control | Sep 15, 2008 |
| Titusville Area Hospital |
Hospital | 5% Or Greater Indirect Ownership Interest | Oct 1, 2015 |
| Titusville Area Hospital |
Hospital | 5% Or Greater Indirect Ownership Interest | Oct 1, 2015 |
| Vna Alliance |
Home health agency | 5% Or Greater Direct Ownership Interest (25%) | Jun 28, 2023 |
| Titusville Area Hospital |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
| Titusville Area Hospital |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
| Titusville Area Hospital |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
| Tionesta Health Center |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Oct 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121205000274 | PA | Part B Supplier - Clinic/Group Practice | 4284535790 |
Receives reassigned benefits from 3 practitioners Practice locations: Meadville, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | Yes |
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
- Meadville Pain Management
Other providers in Meadville, PA
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
- Meadville Medical Center
All providers in Meadville, PA · Pain Medicine (Anesthesiology) Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.