NPIMap

Organization Active NPI

Dubois Regional Medical Center

Doing business as Cameron County Rural Health Center

  • Rural Health Clinic/Center
  • Emporium, PA
National Provider Identifier
1649427071
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DUBOIS REGIONAL MEDICAL CENTER
Doing business as
Cameron County Rural Health Center
Penn Highlands DuBois
Practice address
416 N Broad St
Emporium, PA 15834-1402
Phone
(814) 486-2202
Fax
(814) 486-0973
NPI assigned
Aug 27, 2008
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Authorized official

Name
Mr. Brian S Kline
Title
VP, Cfo & Authorized Official
Phone
(814) 375-6377

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

416 N Broad St
Emporium, PA 15834-1402

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-4200

Other identifiers 1

IdentifierTypeStateIssuer
100774088MedicaidPA

Other names 2

  • Cameron County Rural Health Center Doing business as
  • Penn Highlands DuBois Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050329000620 PA Part B Supplier - Clinic/Group Practice 5890689715 Receives reassigned benefits from 21 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Marys, PA; Du Bois, PA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Penn Highlands Healthcare

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2020 Change of OwnershipThis provider was the seller Penn Highlands ElkCCN 393448, PA, NPI 1245858109

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540857600000",
    "number": "1649427071",
    "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": "814-375-4200",
            "fax_number": "814-375-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 N BROAD ST",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158341402",
            "telephone_number": "814-486-2202",
            "fax_number": "814-486-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2008-08-27",
        "last_updated": "2018-10-30",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VP, CFO & AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "814-375-6377",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100774088",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cameron County Rural Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Penn Highlands DuBois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emporium, PA

Sources for this page

Verify at the official NPI Registry.