Excela Health Physician Practices, Inc.
Organization Active NPI Family Medicine Physician · Mt Pleasant, PA
NPI 1669720868 · NPPES record last updated Feb 11, 2019
Key facts
- NPI
- 1669720868
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- EXCELA HEALTH PHYSICIAN PRACTICES, INC.
- Practice address
- 603 N Church St
Mt Pleasant, PA 15666 - Phone
- (724) 547-3030
- Fax
- (724) 547-4596
- NPI assigned
- Aug 17, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- EXCELA HEALTH HOLDING COMPANY
Authorized official
- Name
- Renee M Varney
- Title
- Lead Credentialing Coord
- Phone
- (724) 850-6933
Corporate family (same tax ID) 41
Practitioners 15
-
Emily M Caldwell, PA-C
-
Angela Dalrymple, RN; CRNP
-
Robert Dejesus, M.D.
-
Julie Erin Devore, D.O., M.P.H.
-
Kayla Keiper, CRNP
-
James J Longhi, D.O.
-
Kerry Luck, MD
-
Daniel Medic Jr., DO
-
Peter W Wilson, PA-C
-
Ilya Y Lantsberg, MD
-
David Lee, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322001393 | PA | Part B Supplier - Clinic/Group Practice | 6204737117 |
Receives reassigned benefits from 767 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Excela Health Connellsville Internal Med-Dr Tiberio
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
603 N Church St
Mt Pleasant, PA 15666
Mailing address
134 Industrial Park Rd Ste 1500
Greensburg, PA 15601-8153
Phone (724) 850-6933
Other names
- Excela Health Mt. Pleasant Family Medicine
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.