NPIMap

Organization Active NPI

Prime Medical Group PCG1

  • Internal Medicine Physician
  • Belle Vernon, PA
National Provider Identifier
1407098643
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD036822L Issued in PA
Legal business name
PRIME MEDICAL GROUP PCG1
Practice address
1645 Rostraver Rd
Suite 202
Belle Vernon, PA 15012-9655
Phone
(724) 929-2260
NPI assigned
Apr 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X MD036822L PA Primary

Addresses

Primary practice location

1645 Rostraver Rd
Suite 202
Belle Vernon, PA 15012-9655

Mailing address

515 Broad Ave
Belle Vernon, PA 15012-1405

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGOtherPAHIGHMARK BLUE SHIELD
0006836970001MedicaidPA

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": "1282521600000",
    "number": "1407098643",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 ROSTRAVER RD",
            "address_2": "SUITE 202",
            "city": "BELLE VERNON",
            "state": "PA",
            "postal_code": "150129655",
            "telephone_number": "724-929-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL GROUP PCG1",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2010-08-23",
        "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": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD036822L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "PENDING",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006836970001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 23, 2010; 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.