NPIMap

Organization Active NPI

Grove City Medical Center

  • Pain Medicine (Anesthesiology) Physician
  • Grove City, PA
National Provider Identifier
1609390483
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
OS005324L Issued in PA
Legal business name
GROVE CITY MEDICAL CENTER
Practice address
631 N Broad Street Ext
Grove City, PA 16127-4603
Phone
(724) 450-7000
Fax
(724) 450-7013
NPI assigned
Aug 2, 2017
Last updated
Aug 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

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

Authorized official

Name
Mr. Robert C Jackson Jr.
Title
Chief Executive Officer
Phone
(724) 450-7197

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X OS005324L PA Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X OS005324L PA

Addresses

Primary practice location

631 N Broad Street Ext
Grove City, PA 16127-4603

Mailing address

631 N. Broad Street Ext.
Grove City, PA 16127-4603
Phone (724) 450-7000

Other identifiers 2

IdentifierTypeStateIssuer
0010895580018MedicaidPA
401500OtherISSUER

Other names 1

  • GCMC Pain Clinic Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501632000000",
    "number": "1609390483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N. BROAD STREET EXT.",
            "city": "GROVE CITY",
            "state": "PA",
            "postal_code": "161274603",
            "telephone_number": "724-450-7000",
            "fax_number": "724-450-7013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N BROAD STREET EXT",
            "city": "GROVE CITY",
            "state": "PA",
            "postal_code": "161274603",
            "telephone_number": "724-450-7000",
            "fax_number": "724-450-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROVE CITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "724-450-7197",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "OS005324L",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "PA",
            "license": "OS005324L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010895580018",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ISSUER",
            "identifier": "401500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GCMC Pain Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grove City, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.