NPIMap

Organization Active NPI

Pennwood Ophthalmic Associates, PC

  • Ophthalmology Physician
  • Everett, PA
National Provider Identifier
1669435582
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PENNWOOD OPHTHALMIC ASSOCIATES, PC
Practice address
311 Hospital Dr
Everett, PA 15537-7022
Phone
(814) 623-1969
Fax
(814) 623-5590
NPI assigned
Apr 11, 2006
Last updated
Feb 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Authorized official

Name
Dr. Katherine Corman Erlichman, D.O.NPI 1730285404
Title
President/Ophthalmology
Phone
(814) 623-1969

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

311 Hospital Dr
Everett, PA 15537-7022

Mailing address

311 Hospital Dr
Everett, PA 15537-7022
Phone (814) 623-1969

Other identifiers 6

IdentifierTypeStateIssuer
172307OtherPABCBS GROUP
0012470110004MedicaidPA
0016242330004MedicaidPA
172508OtherPABCBS GROUP DR SHUKE
0011646070005MedicaidPA
CB2806OtherPARAILROAD MCARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050421000786 PA Part B Supplier - Clinic/Group Practice 4880632645 Receives reassigned benefits from 4 practitioners
Practice locations: Everett, PA
O20100930015271 PA DME Supplier - Physician - Ophthalmology 4880632645 Practice locations: Everett, PA

National Provider Directory

National Provider Directory

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": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1669435582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 HOSPITAL DR",
            "city": "EVERETT",
            "state": "PA",
            "postal_code": "155377022",
            "telephone_number": "814-623-1969",
            "fax_number": "814-623-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 HOSPITAL DR",
            "city": "EVERETT",
            "state": "PA",
            "postal_code": "155377022",
            "telephone_number": "814-623-1969",
            "fax_number": "814-623-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNWOOD OPHTHALMIC ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "ERLICHMAN",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "CORMAN",
        "authorized_official_title_or_position": "PRESIDENT/OPHTHALMOLOGY",
        "authorized_official_telephone_number": "814-623-1969",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "172307",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012470110004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016242330004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP DR SHUKE",
            "identifier": "172508",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011646070005",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE GROUP",
            "identifier": "CB2806",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.