NPIMap

Meadville Medical Center

Organization Active NPI Dermatology Physician · Meadville, PA

NPI 1295097863 · NPPES record last updated Sep 24, 2025

Key facts

NPI
1295097863
Entity type
Organization (NPI type 2)
Primary specialty
Dermatology Physician 207N00000X
Legal business name
MEADVILLE MEDICAL CENTER
Practice address
149 N Main St
Meadville, PA 16335-1112
Phone
(814) 333-5000
NPI assigned
Jun 11, 2012
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 8

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

Other NPIs with the same Medicare PAC ID 20

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

Practitioners 139

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

View all 139

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2046334Meadville Dermatology & Skin Surgery Institute
149 North Main Street, Meadville, PA 16335		ComplianceMar 19, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

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

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207N00000X Yes
Procedural Dermatology Physician
Group: 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

  • Meadville Dermatology and Skin Surgery Institute Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 24, 2025.

{
    "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

All providers in Meadville, PA · Dermatology Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.