NPIMap

Organization Active NPI

South Hills Family Medicine, LLC

  • Family Medicine Physician
  • Bethel Park, PA
National Provider Identifier
1497705784
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTH HILLS FAMILY MEDICINE, LLC
Practice address
1000 Higbee Dr
Suite D202
Bethel Park, PA 15102-4200
Phone
(412) 833-6176
Fax
(412) 833-6421
NPI assigned
May 10, 2006
Last updated
Jun 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Authorized official

Name
Mrs. Kelly Altavilla
Title
Office Manager
Phone
(412) 833-6176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1000 Higbee Dr
Suite D202
Bethel Park, PA 15102-4200

Mailing address

1000 Higbee Dr
Suite D202
Bethel Park, PA 15102-4200
Phone (412) 833-6176

Other identifiers 1

IdentifierTypeStateIssuer
001758961MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041213000262 PA Part B Supplier - Clinic/Group Practice 4284691155 Receives reassigned benefits from 13 practitioners
Practice locations: Bethel Park, PA

National Provider Directory

National Provider Directory

Locations

1000 Higbee Dr
Ste D202
Bethel Park, PA 15102
Phone (412) 833-6176

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1497705784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HIGBEE DR",
            "address_2": "SUITE D202",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151024200",
            "telephone_number": "412-833-6176",
            "fax_number": "412-833-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HIGBEE DR",
            "address_2": "SUITE D202",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151024200",
            "telephone_number": "412-833-6176",
            "fax_number": "412-833-6421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HILLS FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "ALTAVILLA",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "412-833-6176",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001758961",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethel Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.