NPIMap

Organization Active NPI

DLP Conemaugh Physician Practices LLC

Doing business as Conemaugh Physician Group - Portage

  • Rural Health Clinic/Center
  • Portage, PA
National Provider Identifier
1427464874
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Doing business as
Conemaugh Physician Group - Portage
Practice address
3670 Portage St
Ste 105
Portage, PA 15946-6546
Phone
(814) 736-9614
Fax
(814) 736-9783
NPI assigned
Jul 7, 2014
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

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

Addresses

Primary practice location

3670 Portage St
Ste 105
Portage, PA 15946-6546

Mailing address

3670 Portage St
Ste 105
Portage, PA 15946-6546
Phone (814) 736-9614

Other names 1

  • CONEMAUGH PHYSICIAN GROUP - PORTAGE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140915002522 PA Part B Supplier - Clinic/Group Practice 7315166949 Receives reassigned benefits from 836 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20140923000668 PA Part A Provider - Rural Health Clinic 7315166949 Practice locations: Portage, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427464874. Details of each certification follow.

Rural health clinic certification: CCN 393909

Legal name
DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Doing business as
PORTAGE HEALTH CENTER RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2007
Last certification
Jul 10, 2019
Ownership / control type
1B
Most recent change of ownership
Sep 1, 2014 (1 total)
Organization structure
LLCProprietary
Incorporated
May 28, 2014 in DE
Enrollment address
3670 Portage St Ste 105
Portage Health Center RHC
Portage, PA 15946-6548

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

National Provider Directory

National Provider Directory
Tax ID family
Conemaugh Health Initiatives25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

3670 Portage St
Ste 105
Portage, PA 15946
Phone (814) 533-1075

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pamela Kane Individual Corporate OfficerVice President Aug 9, 2022
DSB Acquisition LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 97%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Mar 24, 2022
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
DLP Conemaugh Holding Company LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest May 28, 2014 100%
Klaus Michael Boel Individual Corporate OfficerPresident Aug 19, 2024
W-2 Managing Employee Aug 19, 2024
DLP Lima Partner, LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 17, 2019 97%
Christopher J Monte Individual Corporate OfficerVice President May 28, 2014
Lima Holdco LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 17, 2019 97%

Facilities with the same owner 34

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 34

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1427464874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 PORTAGE ST",
            "address_2": "STE 105",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159466546",
            "telephone_number": "814-736-9614",
            "fax_number": "814-736-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 PORTAGE ST",
            "address_2": "STE 105",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159466546",
            "telephone_number": "814-736-9614",
            "fax_number": "814-736-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DLP CONEMAUGH PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CONEMAUGH PHYSICIAN GROUP - PORTAGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portage, PA

Sources for this page

Verify at the official NPI Registry.