Active NPI
Mount Nittany Health Ventures
- Ambulatory Surgical Clinic/Center
- State College, PA
National Provider Identifier
1689439283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- MOUNT NITTANY HEALTH VENTURES
- Practice address
- 164 Greenview Drive
State College, PA 16803 - Phone
- (814) 231-7000
- Fax
- (814) 238-0790
- NPI assigned
- Feb 14, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Bryan J Roach
- Title
- Cfo
- Phone
- (814) 234-6148
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary | ||
| Endoscopy Clinic/Center | 261QE0800X |
Addresses
Primary practice location
164 Greenview Drive
State College, PA 16803
Mailing address
155 Wellness Way
State College, PA 16803-6702
Phone (814) 231-7000
Other names 1
- Mount Nittany Health Outpatient Endoscopy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250610003800 | PA | Part B Supplier - Ambulatory Surgical Center | 9739699521 | Practice locations: State College, PA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2306204 | Mt Nittany HLTH Op Endoscopy | Compliance | Jan 12, 2028 |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707868800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1773187200000",
"number": "1689439283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 WELLNESS WAY",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168036702",
"telephone_number": "814-231-7000",
"fax_number": "814-238-0790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 GREENVIEW DRIVE",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "16803",
"telephone_number": "814-231-7000",
"fax_number": "814-238-0790"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOUNT NITTANY HEALTH VENTURES",
"organizational_subpart": "NO",
"enumeration_date": "2024-02-14",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A",
"authorized_official_last_name": "ROACH",
"authorized_official_first_name": "BRYAN",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "814-234-6148",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QE0800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Endoscopy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Mount Nittany Health Outpatient Endoscopy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mount Nittany Health Outpatient Endoscopy",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.