NPIMap

Organization Active NPI

Meadville Medical Center

  • Gastroenterology Physician
  • Meadville, PA
National Provider Identifier
1396480372
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MEADVILLE MEDICAL CENTER
Practice address
1034 Grove St Ste G1
Meadville, PA 16335-2945
Phone
(814) 807-1202
Fax
(814) 807-1210
NPI assigned
May 3, 2022
Last updated
May 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Authorized official

Name
Cory Frank Jackson
Title
Controller
Phone
(814) 333-5766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1034 Grove St Ste G1
Meadville, PA 16335-2945

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 807-1202

Other names 1

  • MEADVILLE GASTROENTEROLOGY Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220622002332 PA Part B Supplier - Hospital Department(S) 4284535790 Receives reassigned benefits from 5 practitioners
Practice locations: Meadville, PA

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Meadville Medical Ctr12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Meadville Medical CenterMeadville, PA, CCN 390113 Hospital Operational/Managerial Control Sep 15, 2008
Titusville Area HospitalTitusville, PA, CCN 391314 Hospital 5% Or Greater Indirect Ownership Interest Oct 1, 2015
Titusville Area HospitalTitusville, PA, CCN 39Z314 Hospital 5% Or Greater Indirect Ownership Interest Oct 1, 2015
Vna AllianceMeadville, PA, CCN 397655 Home health agency 5% Or Greater Direct Ownership Interest (25%) Jun 28, 2023
Titusville Area HospitalTitusville, PA, CCN 393438 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Titusville Area HospitalTitusville, PA, CCN 393442 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Titusville Area HospitalOil City, PA, CCN 393441 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015
Tionesta Health CenterTionesta, PA, CCN 393449 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2015

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

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": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1396480372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-807-1202",
            "fax_number": "814-807-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST STE G1",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-807-1202",
            "fax_number": "814-807-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADVILLE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-03",
        "last_updated": "2022-05-03",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "814-333-5766"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEADVILLE GASTROENTEROLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.