NPIMap

Organization Active NPI

Indiana Regional Medical Center

  • Internal Medicine Physician
  • Indiana, PA
National Provider Identifier
1366790750
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
090701 Issued in PA
Legal business name
INDIANA REGIONAL MEDICAL CENTER
Practice address
835 Hospital Rd
Urgicare at Irmc
Indiana, PA 15701-3629
Phone
(724) 357-7493
Fax
(724) 357-6961
NPI assigned
Aug 16, 2012
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Mr. Michael F Ickowski, CPA, MBA
Title
Chief Financial Officer
Phone
(724) 357-7008

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 090701 PA
Internal Medicine Physician 207R00000X 090701 PA Primary

Addresses

Primary practice location

835 Hospital Rd
Urgicare at Irmc
Indiana, PA 15701-3629

Mailing address

PO Box 788
835 Hospital Road
Indiana, PA 15701-0788
Phone (724) 357-7493

Other identifiers 1

IdentifierTypeStateIssuer
1007713530001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000508 PA Part B Supplier - Hospital Department(S) 6800791187 Receives reassigned benefits from 21 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blairsville, PA; Indiana, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1366790750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "address_2": "835 HOSPITAL ROAD",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157010788",
            "telephone_number": "724-357-7493",
            "fax_number": "724-357-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 HOSPITAL RD",
            "address_2": "URGICARE AT IRMC",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013629",
            "telephone_number": "724-357-7493",
            "fax_number": "724-357-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "ICKOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "724-357-7008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "PA",
            "license": "090701",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "090701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007713530001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.

Verify at the official NPI Registry.