NPIMap

Individual provider Active NPI

Petra Danielisz, M.D.

  • Internal Medicine Physician
  • Johnsonburg, PA
National Provider Identifier
1376655456
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD062597L Issued in PA
Practice address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone
(814) 389-4411
Fax
(814) 389-4142
NPI assigned
Aug 31, 2006
Last updated
Feb 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD062597L PA Primary

Addresses

Primary practice location

81 Clarion Rd
Johnsonburg, PA 15845-1656

Mailing address

161 Innsbruck Dr
Emporium, PA 15834-3841
Phone (814) 486-2046

Other identifiers 1

IdentifierTypeStateIssuer
1007763960007MedicaidPA

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
I20050505000496 PA Practitioner - Internal Medicine 6406896869 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upmc KaneGroup PAC ID 7113814625, 29 clinicians

Practice addresses (Care Compare)

81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone (814) 389-4412

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Olean General Hospital Internal Medicine CurrentSince Jan 15, 2018 Accepting new patients
Upmc Kane CurrentSince Mar 1, 2021 Accepting new patients
Olean General Hospital Current Accepting new patients
Upmc Kane Internal Medicine CurrentSince Mar 1, 2021 Accepting new patients

Locations

908 Niagara Falls Blvd
Ste 208
North Tonawanda, NY 14120
Phone (716) 649-1613

116 Interstate Pkwy
Bradford, PA 16701
Phone (814) 362-8674

200 Pleasant St
Bradford, PA 16701
Phone (814) 362-8293

81 Clarion Rd
Johnsonburg, PA 15845
Phone (814) 389-4412

2 Thompson Park
Kane, PA 16735
Phone (814) 837-4770

4372 Route 6
Kane, PA 16735
Phone (814) 837-4540

406 Franklin St
Smethport, PA 16749
Phone (814) 887-5655

Interoperability endpoints

  • Direct secure messaging: danieliszp@kch.securechart.com
  • Direct secure messaging: pdanielisz538006@upmc.direct-ci.com

Organizations & group practices 4

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 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1376655456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 INNSBRUCK DR",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158343841",
            "telephone_number": "814-486-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 CLARION RD",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451656",
            "telephone_number": "814-389-4411",
            "fax_number": "814-389-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELISZ",
        "first_name": "PETRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD062597L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007763960007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnsonburg, PA

Sources for this page

Verify at the official NPI Registry.