NPIMap

Organization Active NPI

Heritage Valley Medical Group, Inc.

  • Internal Medicine Physician
  • Beaver, PA
National Provider Identifier
1659523256
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HERITAGE VALLEY MEDICAL GROUP, INC.
Practice address
1211 3Rd St
Beaver, PA 15009-2530
Phone
(724) 770-0990
NPI assigned
Oct 15, 2008
Organization subpart
Yes
Parent organization
TRI-STATE MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Norman F. Mitry
Title
President & Ceo
Phone
(724) 773-4776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1211 3Rd St
Beaver, PA 15009-2530

Mailing address

1211 3Rd St
Beaver, PA 15009-2530
Phone (724) 770-0990

Other identifiers 2

IdentifierTypeStateIssuer
0015654460023MedicaidPA
0202677MedicaidOH

Other names 1

  • HVMG Associates of Internal Medicine Doing business as

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
39D0913296Heritage Valley Medical Group, Inc1211 3Rd Street, Beaver, PA 15009Certificate of waiverMar 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Tri - State Medical Group Inc92 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1659523256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 3RD ST",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150092530",
            "telephone_number": "724-770-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 3RD ST",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150092530",
            "telephone_number": "724-770-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-STATE MEDICAL GROUP, INC",
        "enumeration_date": "2008-10-15",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "MITRY",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "724-773-4776"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015654460023",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0202677",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HVMG Associates of Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.