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Organization Active NPI

Meadville Medical Center

Doing business as Meadville Dermatology and Skin Surgery Institute

  • Dermatology Physician
  • Meadville, PA
National Provider Identifier
1295097863
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MEADVILLE MEDICAL CENTER
Doing business as
Meadville Dermatology and Skin Surgery Institute
Practice address
149 N Main St
Meadville, PA 16335-1112
Phone
(814) 333-5000
NPI assigned
Jun 11, 2012
Last updated
Sep 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Authorized official

Name
Renato Suntay
Title
VP/Chief Financial Officer
Phone
(814) 333-5030

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

149 N Main St
Meadville, PA 16335-1112

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 333-5762

Other practice location 1

2425 Garden Way Ste 102
Hermitage, PA 16148-5215
Phone (724) 981-1777

Other names 1

  • Meadville Dermatology and Skin Surgery Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120828000091 PA Part B Supplier - Hospital Department(S) 4284535790 Receives reassigned benefits from 7 practitioners
Practice locations: Hermitage, PA; 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

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 7

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": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758672000000",
    "number": "1295097863",
    "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": "814-333-5762",
            "fax_number": "814-333-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 N MAIN ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163351112",
            "telephone_number": "814-333-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 Garden Way Ste 102",
            "address_purpose": "LOCATION",
            "city": "Hermitage",
            "state": "PA",
            "postal_code": "161485215",
            "country_code": "US",
            "telephone_number": "724-981-1777",
            "fax_number": "724-342-2879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEADVILLE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A",
        "authorized_official_last_name": "SUNTAY",
        "authorized_official_first_name": "RENATO",
        "authorized_official_title_or_position": "VP/CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "814-333-5030"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadville Dermatology and Skin Surgery Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.