NPIMap

Organization Active NPI

Medical Associates of Boswell

  • Rural Health Clinic/Center
  • Stoystown, PA
National Provider Identifier
1609829670
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
MD041994E Issued in PA
Legal business name
MEDICAL ASSOCIATES OF BOSWELL
Practice address
136 S Pine Ave
Stoystown, PA 15563-6002
Phone
(814) 893-5568
Fax
(814) 893-5989
NPI assigned
May 18, 2006
Organization subpart
Yes
Parent organization
MEDICAL ASSOCIATES OF BOSWELLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Authorized official

Name
Willilam O. Thompson, M.D.
Title
President
Phone
(814) 893-5568

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X MD041994E PA
Rural Health Clinic/Center 261QR1300X MD041994E PA Primary

Addresses

Primary practice location

136 S Pine Ave
Stoystown, PA 15563-6002

Mailing address

430 Stonycreek St
Boswell, PA 15531-1024
Phone (814) 893-5568

Other identifiers 4

IdentifierTypeStateIssuer
000069206OtherPAHIGHMARK
1007698380001MedicaidPA
000322665OtherPAHIGHMARK
1007698380002MedicaidPA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000498 PA Part B Supplier - Clinic/Group Practice 3870494107 Receives reassigned benefits from 8 practitioners
Practice locations: Boswell, PA
O20070928000616 PA Part A Provider - Rural Health Clinic 3870494107 Practice locations: Boswell, PA

Rural health clinic certification: CCN 393820

Legal name
MEDICAL ASSOCIATES OF BOSWELL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 1, 1980
Last certification
Aug 14, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 1, 1970 in PA
Enrollment address
430 Stonycreek St
Boswell, PA 15531-1024

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
39D0180561Medical Associates of Boswell430 Stonycreek Street, Boswell, PA 15531Provider-performed microscopyMar 6, 2027

National Provider Directory

National Provider Directory
Part of
John R Benner

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Amanda Lynn Toath Individual Corporate OfficerBoard Member Feb 5, 2017
William O Thompson Individual 5% Or Greater Direct Ownership Interest Feb 1, 2007 100%
W-2 Managing Employee Feb 1, 2007 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1609829670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 STONYCREEK ST",
            "city": "BOSWELL",
            "state": "PA",
            "postal_code": "155311024",
            "telephone_number": "814-893-5568",
            "fax_number": "814-893-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 S PINE AVE",
            "city": "STOYSTOWN",
            "state": "PA",
            "postal_code": "155636002",
            "telephone_number": "814-893-5568",
            "fax_number": "814-893-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF BOSWELL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL ASSOCIATES OF BOSWELL",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "WILLILAM",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-893-5568",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD041994E",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "PA",
            "license": "MD041994E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "000069206",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007698380001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "000322665",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007698380002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoystown, PA

Sources for this page

Verify at the official NPI Registry.