NPIMap

Organization Active NPI

Heritage Valley Medical Group, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Monaca, PA
National Provider Identifier
1407415987
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
HERITAGE VALLEY MEDICAL GROUP, INC.
Practice address
79 Wagner Road
Suite 103
Monaca, PA 15061-2338
Phone
(878) 439-3598
Fax
(878) 439-3599
NPI assigned
Jun 10, 2019
Organization subpart
Yes
Parent organization
HERITAGE VALLEYMEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Authorized official

Name
Bryan J Randall
Title
Vice President & Cfo
Phone
(412) 749-7027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

79 Wagner Road
Suite 103
Monaca, PA 15061-2338

Mailing address

1000 Dutch Ridge Rd
Beaver, PA 15009-9727
Phone (724) 773-4776

Other identifiers 1

IdentifierTypeStateIssuer
00156544MedicaidPA

Other names 1

  • HVMG Foot and Ankle Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0175472Heritage Valley Medical Group Inc79 Wagner Road, Suite 202, Monaca, PA 15061Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tri - State Medical Group Inc92 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

79 Wagner Rd
Ste 103
Monaca, PA 15061
Phone (878) 439-3598

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1407415987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 DUTCH RIDGE RD",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150099727",
            "telephone_number": "724-773-4776",
            "fax_number": "724-773-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 WAGNER ROAD",
            "address_2": "SUITE 103",
            "city": "MONACA",
            "state": "PA",
            "postal_code": "150612338",
            "telephone_number": "878-439-3598",
            "fax_number": "878-439-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE VALLEYMEDICAL GROUP, INC.",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "412-749-7027"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00156544",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HVMG Foot and Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monaca, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.