NPIMap

Individual provider Active NPI

Blair Alexander Gorniak, DO

  • Family Medicine Physician
  • Erie, PA
National Provider Identifier
1295304756
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS024260 Issued in PA
Practice address
5515 Peach St
Erie, PA 16509-2603
Phone
(814) 864-4031
NPI assigned
Jun 21, 2021
Last updated
Dec 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS024260 PA Primary

Addresses

Primary practice location

5515 Peach St
Erie, PA 16509-2603

Mailing address

1 Lecom PL
Erie, PA 16505-2571
Phone (814) 868-2529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241227000889 PA Practitioner - Family Practice 2163959446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osteopathic Internal Medicine Associates Inc.Group PAC ID 9739127234, 4 clinicians

Practice addresses (Care Compare)

2010 W 38TH St
Erie, PA 16508-2004
Phone (814) 868-5481

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS024260PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osteopathic Internal Medicine Associates Inc. Internal Medicine CurrentSince Dec 9, 2024 Accepting new patients

Locations

1 Lecom Pl
Erie, PA 16505

2010 W 38th St
Erie, PA 16508
Phone (814) 866-3986

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

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1295304756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LECOM PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052571",
            "telephone_number": "814-868-2529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5515 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-864-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORNIAK",
        "first_name": "BLAIR",
        "middle_name": "ALEXANDER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-21",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS024260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.