NPIMap

Organization Active NPI

Polaris Renewal Services, Inc.

Doing business as MedMark Treatment Centers Perryopolis

  • Methadone Clinic
  • Perryopolis, PA
National Provider Identifier
1619223757
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
POLARIS RENEWAL SERVICES, INC.
Doing business as
MedMark Treatment Centers Perryopolis
Practice address
3591 Pittsburgh Rd
Perryopolis, PA 15473-1307
Phone
(724) 736-8390
NPI assigned
Jul 26, 2012
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

3591 Pittsburgh Rd
Perryopolis, PA 15473-1307

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (214) 379-3300

Other names 1

  • MedMark Treatment Centers Perryopolis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Opioid treatment program
Medicare-enrolled since Apr 14, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200729001982 PA Part B Supplier - Opioid Treatment Program (Otp) 9537598289 1 other NPI on this enrollment
Practice locations: Lemont Furnace, PA; Perryopolis, PA

Other NPIs on the same Medicare enrollment 1

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

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
39D2049832Polaris Renewal Services, Inc3591 Pittsburgh Road, Perryopolis, PA 15473Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Polaris Renewal Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3591 Pittsburgh Rd
Perryopolis, PA 15473
Phone (724) 736-8390

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1619223757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300",
            "fax_number": "214-853-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3591 PITTSBURGH RD",
            "city": "PERRYOPOLIS",
            "state": "PA",
            "postal_code": "154731307",
            "telephone_number": "724-736-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLARIS RENEWAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Perryopolis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perryopolis, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.