NPIMap

Organization Active NPI

Centerville Clinics, Inc.

  • Radiologic Technologist
  • Fredericktown, PA
National Provider Identifier
1568566867
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiologic TechnologistTaxonomy code 247100000X
License
1501927 Issued in PA
Legal business name
CENTERVILLE CLINICS, INC.
Practice address
1070 Old National Pike
Fredericktown, PA 15333-2114
Phone
(724) 632-6801
Fax
(724) 632-6312
NPI assigned
Sep 8, 2006
Last updated
Jun 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

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

Authorized official

Name
Mrs. Patricia Martos
Title
Director Personnel/Finance
Phone
(724) 632-6801

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiologic Technologist 247100000X 1501927 PA Primary
Mammography Radiologic Technologist 2471M2300X 105916 PA

Addresses

Primary practice location

1070 Old National Pike
Fredericktown, PA 15333-2114

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Other identifiers 1

IdentifierTypeStateIssuer
2157508OtherPAHIGHMARK BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427000681 PA Part B Supplier - Clinic/Group Practice 7214837202 Receives reassigned benefits from 86 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bentleyville, PA; Washington, PA; Uniontown, PA; Masontown, PA; Fredericktown, PA; Donora, PA; Connellsville, PA; Charleroi, PA…

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Centerville Clinics Inc66 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 85

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 85

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1568566867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR PERSONNEL/FINANCE",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "PA",
            "license": "1501927",
            "primary": true
        },
        {
            "code": "2471M2300X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Mammography",
            "state": "PA",
            "license": "105916",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "2157508",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericktown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; 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.