NPIMap

Organization Active NPI

Millcreek Manor

  • Internal Medicine Physician
  • Erie, PA
National Provider Identifier
1679252118
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MILLCREEK MANOR
Practice address
5401 Peach St Ste 3400
Erie, PA 16509-2601
Phone
(814) 868-2200
NPI assigned
Jul 12, 2023
Organization subpart
Yes
Parent organization
MILLCREEK MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Olivia J Topel
Title
Cfo
Phone
(814) 881-5234

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X

Addresses

Primary practice location

5401 Peach St Ste 3400
Erie, PA 16509-2601

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 881-5234

Other names 1

  • Clinical Practice of LECOM Institute for Successful Living Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231102002073 PA Part B Supplier - Clinic/Group Practice 1456424084 Receives reassigned benefits from 5 practitioners
Practice locations: Erie, PA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Lecom Home Care

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Lecom at Village Square LLCErie, PA, CCN 395672 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 3, 2019
Lecom Senior Living CenterErie, PA, CCN 395474 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 3, 2023
Lecom at Snyder MemorialMarienville, PA, CCN 395728 Skilled nursing facility Adp of the SNF Jun 1, 2025
Saint Mary's at Asbury RidgeErie, PA, CCN 396081 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Trustee of the SNF
Adp of the SNF		 May 1, 2025
May 1, 2025
May 1, 2025
Rural Health Clinic of WattsburgErie, PA, CCN 393929 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 24, 2023
Rural Health Clinic of AshtabulaAshtabula, OH, CCN 363882 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 19, 2024
Rural Health Clinic of MeadvilleMeadville, PA, CCN 393930 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1989

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1679252118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-881-5234",
            "fax_number": "814-871-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST STE 3400",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601",
            "telephone_number": "814-868-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK MANOR",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "TOPEL",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-881-5234"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical Practice of LECOM Institute for Successful Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.