NPIMap

Individual provider Active NPI

Edgar Bonchita Gantalao, M.D.

  • Psychiatry Physician
  • Du Bois, PA
National Provider Identifier
1649200411
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD418498 Issued in PA
Practice address
535 Sunflower Dr
Du Bois, PA 15801-2364
Phone
(814) 375-6379
Fax
(814) 375-9320
NPI assigned
Jul 4, 2006
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD418498 PA Primary

Addresses

Primary practice location

535 Sunflower Dr
Du Bois, PA 15801-2364

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-6379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101012001333 PA Practitioner - Psychiatry 9638361355 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians

Practice addresses (Care Compare)

635 Maple Ave
DRMC Behaviorial HLTH
Dubois, PA 15801-2383
Phone (814) 375-6379

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Brookville Hospital CurrentSince Aug 1, 2012 Accepting new patients
Dubois Regional Medical Center CurrentSince Jun 1, 2002 Accepting new patients
Dubois Regional Medical Center Psychiatry CurrentSince Jun 1, 2002 Accepting new patients
Brookville Hospital CurrentSince Aug 1, 2012 Accepting new patients
Brookville Hospital CurrentSince Dec 1, 2025 Accepting new patients
Elk Regional Health Center CurrentSince Feb 1, 2015 Accepting new patients
Elk Regional Health Center Psychiatry CurrentSince Feb 1, 2015 Accepting new patients
Clearfield Hospital Past Accepting new patients
Clearfield Hospital Past Accepting new patients
Dubois Regional Medical Center Past Accepting new patients

Locations

100 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1408

1033 Turnpike Ave
Ste 100
Clearfield, PA 16830
Phone (814) 765-7585

1033 Turnpike Ave
Ste 300
Clearfield, PA 16830
Phone (814) 768-2137

531 Hannah St
Ste A
Clearfield, PA 16830
Phone (814) 765-0375

809 Turnpike Ave
Clearfield, PA 16830
Phone (814) 765-5341

820 Turnpike Ave
Clearfield, PA 16830
Phone (814) 765-2006

100 Caldwell Dr
Dubois, PA 15801

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

535 Sunflower Dr
Dubois, PA 15801
Phone (814) 375-6338

90 Beaver Dr
Ste 121D
Dubois, PA 15801
Phone (814) 371-3323

275 E 4th St
Emporium, PA 15834
Phone (814) 486-6123

111 Cobb St
Johnsonburg, PA 15845
Phone (814) 965-2857

763 Johnsonburg Rd
Saint Marys, PA 15857
Phone (814) 788-8000

Interoperability endpoints

  • Direct secure messaging: ebgantalao@1285.direct.myezyaccess.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1649200411",
    "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": "814-375-6379",
            "fax_number": "814-375-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 SUNFLOWER DR",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012364",
            "telephone_number": "814-375-6379",
            "fax_number": "814-375-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTALAO",
        "first_name": "EDGAR",
        "middle_name": "BONCHITA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD418498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.