Active NPI
Medical Associates of Erie
Doing business as Fairview Family Medicine
- Family Medicine Physician
- Fairview, PA
National Provider Identifier
1366560815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MEDICAL ASSOCIATES OF ERIE
- Doing business as
- Fairview Family Medicine
- Practice address
- 7686 West Ridge Rd
Fairview, PA 16415 - Phone
- (814) 474-2654
- Fax
- (814) 474-2656
- NPI assigned
- Mar 26, 2007
- Last updated
- Apr 21, 2011
- 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
- Mr. Dennis M Styn
- Title
- Ceo
- Phone
- (814) 868-2504
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NU | Primary |
Addresses
Primary practice location
7686 West Ridge Rd
Fairview, PA 16415
Mailing address
One Lecom Place
Erie, PA 16505-2571
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1010664580004 | Medicaid | PA |
Other names 1
- Fairview Family Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051205000786 | PA | Part B Supplier - Clinic/Group Practice | 2769402783 |
Receives reassigned benefits from 71 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Waterford, PA; Meadville, PA; Erie, PA; Albion, PA |
Other NPIs on the same Medicare enrollment 11
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Primary Care at the Achievement Center
- Family Medicine Physician
- Erie, PA
- NPI 1164304903
O20051205000786
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1303344000000",
"number": "1366560815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE LECOM PLACE",
"city": "ERIE",
"state": "PA",
"postal_code": "165052571",
"fax_number": "814-868-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7686 WEST RIDGE RD",
"city": "FAIRVIEW",
"state": "PA",
"postal_code": "16415",
"telephone_number": "814-474-2654",
"fax_number": "814-474-2656"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICAL ASSOCIATES OF ERIE",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-26",
"last_updated": "2011-04-21",
"status": "A",
"authorized_official_last_name": "STYN",
"authorized_official_first_name": "DENNIS",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "814-868-2504",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1010664580004",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fairview Family Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fairview, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.