NPIMap

Individual provider Active NPI

Collette Grossman, PA-C

  • Physician Assistant
  • Butler, PA
National Provider Identifier
1558108183
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA065542 Issued in PA
Practice address
104 Technology Dr Ste 204
Butler, PA 16001-1801
Phone
(833) 995-0121
NPI assigned
Jul 11, 2024
Last updated
Jul 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA065542 PA Primary

Addresses

Primary practice location

104 Technology Dr Ste 204
Butler, PA 16001-1801

Mailing address

131 Grossman Rd
Slippery Rock, PA 16057-5405

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828003613 PA Practitioner - Physician Assistant 5496294902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Butler Medical ProvidersGroup PAC ID 7416840160, 355 clinicians

Practice addresses (Care Compare)

102 Technology Dr
Butler, PA 16001-1784

104 Technology Dr
Butler, PA 16001-1801

127 Oneida Valley Rd
Suite 400
Butler, PA 16001-2251
Phone (833) 995-0118

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Butler Medical Providers CurrentSince Jul 22, 2024 Accepting new patients
Butler Medical Providers CurrentSince Jul 22, 2024 Accepting new patients
Butler Medical Providers Past Accepting new patients

Locations

102 Technology Dr
Ste 110A
Butler, PA 16001
Phone (833) 917-0873

104 Technology Dr
Ste 204
Butler, PA 16001
Phone (724) 482-4257

127 Oneida Valley Rd
Ste 400
Butler, PA 16001
Phone (724) 431-0550

24 Doctors Ln
Ste 201
Clarion, PA 16214
Phone (833) 684-1898

24 Doctors Ln
Ste 202
Clarion, PA 16214
Phone (814) 226-2500

24 Doctors Ln
Ste 301
Clarion, PA 16214
Phone (814) 226-9500

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1558108183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 GROSSMAN RD",
            "city": "SLIPPERY ROCK",
            "state": "PA",
            "postal_code": "160575405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 TECHNOLOGY DR STE 204",
            "city": "BUTLER",
            "state": "PA",
            "postal_code": "160011801",
            "telephone_number": "833-995-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "COLLETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA065542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Butler, PA

Sources for this page

Verify at the official NPI Registry.