Active NPI
Jersey Shore Hospital
- Emergency Medicine Physician
- Jersey Shore, PA
National Provider Identifier
1306989967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 101401
- Legal business name
- JERSEY SHORE HOSPITAL
- Practice address
- 1020 Thompson St
Jersey Shore, PA 17740-1729 - Phone
- (570) 398-0100
- Fax
- (570) 398-4412
- NPI assigned
- Feb 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark A. O'Neill
- Title
- Cfo
- Phone
- (570) 398-3100
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 101401 | PA | |
| Emergency Medicine Physician | 207P00000X | 101401 | PA | Primary |
| Diagnostic Radiology Physician | 2085R0202X | 101401 | PA | |
| Critical Access Hospital | 282NC0060X | 101401 | PA | |
| Surgical Physician Assistant | 363AS0400X | 101401 | PA | |
| Certified Registered Nurse Anesthetist | 367500000X | 101401 | PA |
Addresses
Primary practice location
1020 Thompson St
Jersey Shore, PA 17740-1729
Mailing address
1020 Thompson St
Jersey Shore, PA 17740-1729
Phone (570) 398-0100
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222070 | Other | PA | RADIOLOGY FPH |
| 391300 | Other | PA | WORKERS COMP |
| 1007703560004 | Medicaid | PA | |
| 230275 | Other | PA | HA RADIOLOGY |
| 3634 | Other | PA | GHP |
| C10719 | Other | PA | RR MEDICARE DR GROUP |
| 116482 | Other | PA | HA ER |
| 139690 | Other | PA | HA ANESTHSIA |
| 222069 | Other | PA | ER FPH |
Other names 1
- JSECPA
National Provider Directory
National Provider Directory- Tax ID family
- Jersey Shore Hosp Lab
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinic/Center
- Lock Haven, PA
- NPI 1275128381
-
- Ambulatory Surgical Clinic/Center
- Jersey Shore, PA
- NPI 1194868729
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193443200000",
"number": "1306989967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 THOMPSON ST",
"city": "JERSEY SHORE",
"state": "PA",
"postal_code": "177401729",
"telephone_number": "570-398-0100",
"fax_number": "570-398-4412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 THOMPSON ST",
"city": "JERSEY SHORE",
"state": "PA",
"postal_code": "177401729",
"telephone_number": "570-398-0100",
"fax_number": "570-398-4412"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JERSEY SHORE HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-14",
"last_updated": "2007-10-27",
"status": "A",
"authorized_official_last_name": "O'NEILL",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "570-398-3100"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "101401",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": "PA",
"license": "101401",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": "PA",
"license": "101401",
"primary": false
},
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "PA",
"license": "101401",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant, Surgical",
"state": "PA",
"license": "101401",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "PA",
"license": "101401",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RADIOLOGY FPH",
"identifier": "222070",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP",
"identifier": "391300",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007703560004",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HA RADIOLOGY",
"identifier": "230275",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "3634",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE DR GROUP",
"identifier": "C10719",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HA ER",
"identifier": "116482",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HA ANESTHSIA",
"identifier": "139690",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ER FPH",
"identifier": "222069",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "JSECPA",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jersey Shore, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.