NPIMap

Organization Active NPI

Mount Nittany Medical Center Health Services Inc

Doing business as Mount Nittany Physician Group

  • Hematology & Oncology Physician
  • State College, PA
National Provider Identifier
1629874748
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC
Doing business as
Mount Nittany Physician Group
Practice address
235 Wellness Way
State College, PA 16803-6701
Phone
(814) 231-7000
Fax
(814) 238-0790
NPI assigned
Feb 20, 2025
Last updated
Apr 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Authorized official

Name
Bryan Roach
Title
Cfo
Phone
(814) 231-7011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X Primary

Addresses

Primary practice location

235 Wellness Way
State College, PA 16803-6701

Mailing address

155 Wellness Way
State College, PA 16803-6709
Phone (814) 231-7000

Other practice location 1

155 Wellness Way
State College, PA 16803-6701
Phone (814) 231-7100 ext. 3490

Other practice location 2

1800 E Park Ave
State College, PA 16803-6701
Phone (814) 231-7100 ext. 3490

Other names 1

  • Mount Nittany Physician Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250710000752 PA Part B Supplier - Hospital Department(S) 8426136797 Receives reassigned benefits from 4 practitioners
Practice locations: State College, PA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mount Nittany Med Ctr HLTH4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

235 Wellness Way
State College, PA 16803
Phone (814) 231-7800

Practitioners & affiliated clinicians

Practitioners 4

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": "1740009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1629874748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036709",
            "telephone_number": "814-231-7000",
            "fax_number": "814-238-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036701",
            "telephone_number": "814-231-7000",
            "fax_number": "814-238-0790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Wellness Way",
            "address_purpose": "LOCATION",
            "city": "State College",
            "state": "PA",
            "postal_code": "168036701",
            "country_code": "US",
            "telephone_number": "814-231-7100 x3490",
            "fax_number": "814-238-0790",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 E Park Ave",
            "address_purpose": "LOCATION",
            "city": "State College",
            "state": "PA",
            "postal_code": "168036701",
            "country_code": "US",
            "telephone_number": "814-231-7100 x3490",
            "fax_number": "814-238-0790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-20",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-231-7011"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Nittany Physician Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Nittany Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.

Verify at the official NPI Registry.