NPIMap

Organization Active NPI

Phillip States, MD, Family Practice

  • Rural Health Clinic/Center
  • Punxsutawney, PA
National Provider Identifier
1376865816
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
393918 Issued in PA
Legal business name
PHILLIP STATES, MD, FAMILY PRACTICE
Practice address
81 Hillcrest Dr
Suite 1300
Punxsutawney, PA 15767-2605
Phone
(814) 938-3550
Fax
(814) 938-3679
NPI assigned
Feb 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Dr. Phillip J States, MD
Title
Owner/Proprietor
Phone
(814) 938-3550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 393918 PA Primary

Addresses

Primary practice location

81 Hillcrest Dr
Suite 1300
Punxsutawney, PA 15767-2605

Mailing address

81 Hillcrest Dr
Suite 1300
Punxsutawney, PA 15767-2605
Phone (814) 938-3550

Other identifiers 2

IdentifierTypeStateIssuer
393918OtherPACMS CERTIFICATION NUMBER
1019257860003MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Phillip J States Lab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1376865816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 HILLCREST DR",
            "address_2": "SUITE 1300",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157672605",
            "telephone_number": "814-938-3550",
            "fax_number": "814-938-3679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 HILLCREST DR",
            "address_2": "SUITE 1300",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157672605",
            "telephone_number": "814-938-3550",
            "fax_number": "814-938-3679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP STATES, MD, FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "STATES",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PROPRIETOR",
        "authorized_official_telephone_number": "814-938-3550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "PA",
            "license": "393918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION NUMBER",
            "identifier": "393918",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019257860003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Punxsutawney, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.