NPIMap

Organization Active NPI

Prime Medical Group PCG1

  • Cardiovascular Disease Physician
  • Belle Vernon, PA
National Provider Identifier
1386886539
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD042211C Issued in PA
Legal business name
PRIME MEDICAL GROUP PCG1
Practice address
1645 Rostraver Rd
Suite 505
Belle Vernon, PA 15012-9655
Phone
(724) 929-4930
Fax
(724) 929-4308
NPI assigned
Apr 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

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

Authorized official

Name
Darla Sethman
Title
Practice Administrator
Phone
(724) 929-2640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X MD042211C PA Primary

Addresses

Primary practice location

1645 Rostraver Rd
Suite 505
Belle Vernon, PA 15012-9655

Mailing address

515 Broad Ave
Belle Vernon, PA 15012-1405
Phone (724) 929-4930

Other identifiers 2

IdentifierTypeStateIssuer
0014690470002MedicaidPA
PENDINGOtherPAHIGHMARK BLUE SHIELD

Other names 1

  • PR Cardiovascular Division Other name

National Provider Directory

National Provider Directory
Tax ID family
Prime Medical Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1238630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1386886539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BROAD AVE",
            "city": "BELLE VERNON",
            "state": "PA",
            "postal_code": "150121405",
            "telephone_number": "724-929-4930",
            "fax_number": "724-929-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 ROSTRAVER RD",
            "address_2": "SUITE 505",
            "city": "BELLE VERNON",
            "state": "PA",
            "postal_code": "150129655",
            "telephone_number": "724-929-4930",
            "fax_number": "724-929-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL GROUP PCG1",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "SETHMAN",
        "authorized_official_first_name": "DARLA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "724-929-2640"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD042211C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014690470002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "PENDING",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PR Cardiovascular Division",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Belle Vernon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.