Active NPI
Dubois Regional Medical Group, PC
- Pediatrics Physician
- Brookville, PA
National Provider Identifier
1609960251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- DUBOIS REGIONAL MEDICAL GROUP, PC
- Practice address
- 2834 Maplevale Rd
Brookville, PA 15825-2318 - Phone
- (814) 849-3014
- Fax
- (814) 849-3710
- NPI assigned
- Oct 3, 2006
- Last updated
- Mar 23, 2015
- Organization subpart
- Yes
- Parent organization
- PENN HIGHLANDS HDUBOIS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John S Sutika, CPA
- Title
- President
- Phone
- (814) 375-3385
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Nurse Practitioner | 363L00000X | |||
| Pediatrics Physician | 208000000X | Primary |
Addresses
Primary practice location
2834 Maplevale Rd
Brookville, PA 15825-2318
Mailing address
100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-6560
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002018650 | Other | PA | HIGHMARK ASSIGNMENT ACCOUNT |
| 1007519310003 | Medicaid | PA | |
| 1007519310008 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040119000522 | PA | Part B Supplier - Clinic/Group Practice | 8022917269 |
Receives reassigned benefits from 46 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Monongahela, PA; Tyrone, PA; Philipsburg, PA; Punxsutawney, PA; Saint Marys, PA; St Mary, PA; St Marys, PA; State College, PA… |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Du Bois, PA
- NPI 1093956617
O20040119000522
-
- Multi-Specialty Clinic/Center
- Du Bois, PA
- NPI 1285728915
O20040119000522
National Provider Directory
National Provider Directory- Part of
- Dubois Regional Medical Center - Penn Highlands Dubois Medical Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1427068800000",
"number": "1609960251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 HOSPITAL AVE",
"city": "DU BOIS",
"state": "PA",
"postal_code": "158011440",
"telephone_number": "814-375-6560",
"fax_number": "814-372-2848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2834 MAPLEVALE RD",
"city": "BROOKVILLE",
"state": "PA",
"postal_code": "158252318",
"telephone_number": "814-849-3014",
"fax_number": "814-849-3710"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DUBOIS REGIONAL MEDICAL GROUP, PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PENN HIGHLANDS HDUBOIS",
"enumeration_date": "2006-10-03",
"last_updated": "2015-03-23",
"status": "A",
"authorized_official_last_name": "SUTIKA",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "814-375-3385",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CPA"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK ASSIGNMENT ACCOUNT",
"identifier": "002018650",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007519310003",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007519310008",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookville, PA
- Dubois Regional Medical Center (DRMC Brookville Family Health)
- Dubois Regional Medical Center (Penn Highlands DuBois Summit St Bldg)
- Dubois Regional Medical Center (Penn Highlands Allegheny Health Center RHC)
- Dubois Regional Medical Center (Penn Highlands Dubois Family Med-Prusakowski)
- Dubois Regional Medical Center - Penn Highlands Charles Medical Center (Penn Highlands DuBois)
- Janice D Dunkle, O.D.
- Chelsea M Dunn, OD
- Family Therapy Services Inc.
- William James Fernan
- Jason R Fetterman, D.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.