NPIMap

Organization Active NPI

Titusville Area Hospital

  • Rural Health Clinic/Center
  • Saegertown, PA
National Provider Identifier
1609338334
Registry record updated Apr 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TITUSVILLE AREA HOSPITAL
Practice address
401 Main St
Saegertown, PA 16433-0846
Phone
(814) 763-1106
Fax
(814) 763-1129
NPI assigned
Apr 2, 2019
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jill Ann Neely
Title
Chief Financial Officer
Phone
(814) 827-1851

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Practitioners 79

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 79

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2053598Saegertown Medical Associates401 Main Street, Saegertown, PA 16433Certificate of waiverFeb 3, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190515002147 PA Part A Provider - Rural Health Clinic 8022907575 Practice locations: Saegertown, PA
O20190603002047 PA Part B Supplier - Hospital Department(S) 8022907575 Receives reassigned benefits from 44 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cambridge Springs, PA; Conneaut Lake, PA; Conneautville, PA; Meadville, PA; Saegertown, PA

Rural health clinic certification: CCN 393440

Legal name
TITUSVILLE AREA HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 23, 2018
Last certification
May 31, 2024
Ownership / control type
2B
Most recent change of ownership
Jun 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1984 in PA
Enrollment address
401 Main St
Saegertown, PA 16433-0846
Related CCNs
391314

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 3

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jill a Neely Individual Corporate OfficerChief Financial Officer Jun 1, 2019
W-2 Managing EmployeeChief Financial Officer Jun 1, 2019
Cory F Jackson Individual W-2 Managing EmployeeController Jun 1, 2019
Renato Suntay Individual Operational/Managerial ControlCfo Jun 1, 2019

Change-of-ownership history 1

Medicare enrollment files
DateEventCounterparty
Jun 1, 2019 Change of OwnershipThis provider was the buyer Meadville Medical CenterCCN 393440, PA, NPI 1144550476

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

401 Main St
Saegertown, PA 16433-0846

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 763-1106

Other names 1

NPPES NPI Registry
  • SAEGERTOWN MEDICAL ASSOCIATES Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 2, 2019.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554163200000",
    "number": "1609338334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-763-1106",
            "fax_number": "814-763-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAIN ST",
            "city": "SAEGERTOWN",
            "state": "PA",
            "postal_code": "164330846",
            "telephone_number": "814-763-1106",
            "fax_number": "814-763-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TITUSVILLE AREA HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A",
        "authorized_official_last_name": "NEELY",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "814-827-1851"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAEGERTOWN MEDICAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saegertown, PA

Sources for this page

Verify at the official NPI Registry.