NPIMap

Organization Active NPI

Clinical Practice of Lecom Institute for Successful Living

Doing business as LECOM Institute for Successful Living at Meadville

  • Family Medicine Physician
  • Meadville, PA
National Provider Identifier
1447072731
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Doing business as
LECOM Institute for Successful Living at Meadville
Practice address
16954 Conneaut Lake Rd
Meadville, PA 16335-3738
Phone
(814) 868-2200
NPI assigned
Oct 28, 2024
Last updated
Feb 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLCREEK MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Authorized official

Name
James LinNPI 1164599155
Title
President
Phone
(814) 602-7783

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Interventional Cardiology Physician 207RI0011X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

16954 Conneaut Lake Rd
Meadville, PA 16335-3738

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 844-2858

Other names 1

  • LECOM Institute for Successful Living at Meadville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240402000412 PA Part B Supplier - Clinic/Group Practice 2466890033 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Erie, PA; Meadville, PA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Clinical Practice of Lecom Institute for Successful Living5 organizations share this tax ID, including this one
Part of
Millcreek Manor Pharmacy

Other organizations with this tax ID 4

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

Locations

16954 Conneaut Lake Rd
Ste B
Meadville, PA 16335

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": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1447072731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-844-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16954 CONNEAUT LAKE RD",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353738",
            "telephone_number": "814-868-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK MANOR",
        "enumeration_date": "2024-10-28",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "LIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-602-7783"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Institute for Successful Living at Meadville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LECOM Institute for Successful Living at Meadville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.