NPIMap

Individual provider Active NPI

Mark H Shelley, M.D.

  • Family Medicine Physician
  • Port Allegany, PA
National Provider Identifier
1336106954
Registry record updated Nov 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD029656E Issued in PA
Practice address
1 Willow St
Port Allegany, PA 16743-1332
Phone
(814) 642-9531
Fax
(814) 642-2020
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2010

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 MD029656E PA Primary

Addresses

Primary practice location

1 Willow St
Port Allegany, PA 16743-1332

Mailing address

1 Willow St
Port Allegany, PA 16743-1332
Phone (814) 642-9531

Other identifiers 3

IdentifierTypeStateIssuer
001403288001MedicaidPA
75710OtherPAHIGHMARK BLUE SHIELD
080023500OtherPARAILROAD MEDICARE

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
I20101022001186 PA Practitioner - Family Practice 3173594991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Port Allegany Area Family Practice PCGroup PAC ID 4789669144, 3 clinicians

Practice addresses (Care Compare)

1 Willow St
Port Allegany, PA 16743-1332
Phone (814) 642-9531

Hospital & facility affiliations

  • Upmc Home Healthcare Home health agency, Williamsport, PA, CCN 397006
  • Vna of Northwest PA, LLC Home health agency, Bradford, PA, CCN 397130
  • Olean General Hospital Hospital, Olean, NY, CCN 330103
  • Upmc Cole Hospital, Coudersport, PA, CCN 391313
  • Sena Kean Nursing and Rehabilitation Nursing home, Smethport, PA, CCN 395775
  • Sweden Valley Manor Nursing home, Coudersport, PA, CCN 395699

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD029656EPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Port Allegany Area Family Practice PC Family Medicine CurrentSince May 21, 1985 Accepting new patients
HCF of Sweden Valley, Inc. Past Accepting new patients
Sena Kean SNF Operations LLC Past Accepting new patients

Locations

1 Willow St
Port Allegany, PA 16743
Phone (814) 642-9531

17083 Route 6
Smethport, PA 16749
Phone (814) 887-4605

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Upper Allegheny Medical CenterPort Allegany, PA, CCN 393849 Rural health clinic Corporate Director (100%) Jan 1, 2009

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 3

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

Hospital & facility affiliations 8

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290556800000",
    "number": "1336106954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WILLOW ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431332",
            "telephone_number": "814-642-9531",
            "fax_number": "814-642-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WILLOW ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431332",
            "telephone_number": "814-642-9531",
            "fax_number": "814-642-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLEY",
        "first_name": "MARK",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD029656E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001403288001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "75710",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080023500",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Allegany, PA

Sources for this page

Verify at the official NPI Registry.