NPIMap

Organization Active NPI

Punxsutawney Area Hospital Inc

Doing business as Punxsutawney Area Hospital Inc Outpatient Program

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Punxsutawney, PA
National Provider Identifier
1669558391
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
941360 Issued in PA
Legal business name
PUNXSUTAWNEY AREA HOSPITAL INC
Doing business as
Punxsutawney Area Hospital Inc Outpatient Program
Practice address
81 Hillcrest Dr
Punxsutawney, PA 15767-2605
Phone
(814) 938-1800
Fax
(814) 938-1855
NPI assigned
Oct 27, 2006
Last updated
Apr 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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

Authorized official

Name
Mr. Jack Sisk
Title
Cfo
Phone
(814) 938-1882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 941360 PA Primary

Addresses

Primary practice location

81 Hillcrest Dr
Punxsutawney, PA 15767-2605

Mailing address

81 Hillcrest Dr
Punxsutawney, PA 15767-2605
Phone (814) 938-1800

Other identifiers 3

IdentifierTypeStateIssuer
081893OtherHIGHMARK MEDICARE SERVICE
1007712640030MedicaidPA
1377OtherPAHIGHMARK BLUE CROSS

Other names 1

  • PUNXSUTAWNEY AREA HOSPITAL INC OUTPATIENT PROGRAM Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040826000050 PA Part B Supplier - Clinic/Group Practice 3375517147 Receives reassigned benefits from 3 practitioners
Practice locations: Punxsutawney, PA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory

Locations

81 Hillcrest Dr
Ste 1200
Punxsutawney, PA 15767
Phone (814) 938-1830

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Punxsutawney Home Health CarePunxsutawney, PA, CCN 397096 Home health agency 5% Or Greater Direct Ownership Interest Sep 2, 1970
Punxsutawney Area Hospital Rural Health ClinicPunxsutawney, PA, CCN 393451 Rural health clinic Operational/Managerial Control Nov 30, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1669558391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 HILLCREST DR",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157672605",
            "telephone_number": "814-938-1800",
            "fax_number": "814-938-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 HILLCREST DR",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157672605",
            "telephone_number": "814-938-1800",
            "fax_number": "814-938-1855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUNXSUTAWNEY AREA HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "SISK",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-938-1882",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PA",
            "license": "941360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK MEDICARE SERVICE",
            "identifier": "081893",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007712640030",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE CROSS",
            "identifier": "1377",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUNXSUTAWNEY AREA HOSPITAL INC OUTPATIENT PROGRAM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Punxsutawney, PA

Sources for this page

Verify at the official NPI Registry.