Individual provider Active NPI

John Puthenpurackal John, MD

  • Psychiatry Physician
  • Warren, PA
National Provider Identifier
1497789507
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD051025L Issued in PA
Practice address
1885 Market St
Warren, PA 16365-1277
Phone
(814) 723-5545
Fax
(814) 723-6355
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD051025L PA Primary

Addresses

Primary practice location

1885 Market St
Warren, PA 16365-1277

Mailing address

1885 Market St
Warren, PA 16365-1277
Phone (814) 723-5545

Other identifiers 1

IdentifierTypeStateIssuer
001599598MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060323000267 PA Practitioner - Psychiatry 5193733780 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
State University of New York at Buffalo School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Deerfield Behavioral Health of Warren, LLCGroup PAC ID 8325935661, 8 clinicians
Childrens Center for Treatment and EducationGroup PAC ID 4880750017, 8 clinicians

Practice addresses (Care Compare)

1885 Market St
Warren, PA 16365-1277
Phone (814) 817-1400

23 Kennedy St
Bradford, PA 16701-2065
Phone (814) 817-1400

613 Elm St
Tionesta, PA 16353-9751
Phone (814) 817-1400

800 E Main St
Bradford, PA 16701-3278
Phone (814) 817-1400

Hospital & facility affiliations

  • Warren General Hospital Hospital, Warren, PA, CCN 391319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD051025LPAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Center for Treatment and Education CurrentSince Aug 4, 2008 Accepting new patients
Children'S Center for Treatment and Education Current Accepting new patients
Warren County Commissioners Past Accepting new patients

Locations

23 Kennedy St
Bradford, PA 16701
Phone (814) 723-1832

1885 Market St
Warren, PA 16365
Phone (814) 723-1832

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1497789507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 MARKET ST",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163651277",
            "telephone_number": "814-723-5545",
            "fax_number": "814-723-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 MARKET ST",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163651277",
            "telephone_number": "814-723-5545",
            "fax_number": "814-723-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "JOHN",
        "middle_name": "PUTHENPURACKAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD051025L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001599598",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, PA

Sources for this page

Verify at the official NPI Registry.