NPIMap

Organization Active NPI

Clinical Practice of Lecom Institute for Successful Living

Doing business as Rural Health Clinic of Meadville

  • Rural Health Clinic/Center
  • Meadville, PA
National Provider Identifier
1689489718
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Doing business as
Rural Health Clinic of Meadville
Practice address
16954 Conneaut Lake Rd
Meadville, PA 16335-3738
Phone
(814) 844-2858
NPI assigned
Feb 7, 2025
Last updated
Oct 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLCREEK MANORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Authorized official

Name
James LinNPI 1164599155
Title
President
Phone
(814) 602-7783

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

16954 Conneaut Lake Rd
Meadville, PA 16335-3738

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 844-2858

Other names 1

  • Rural Health Clinic of Meadville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250509002826 PA Part A Provider - Rural Health Clinic 2466890033 Practice locations: Meadville, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689489718. Details of each certification follow.

Rural health clinic certification: CCN 393930

Legal name
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Doing business as
RURAL HEALTH CLINIC OF MEADVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 30, 2025
Last certification
Jun 30, 2025
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
16954 Conneaut Lake Rd
Meadville, PA 16335-3738

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2321108Rural Health Clinic of Meadville16954 Conneaut Lake Rd, Meadville, PA 16335Certificate of waiverMar 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Clinical Practice of Lecom Institute for Successful Living5 organizations share this tax ID, including this one
Part of
Millcreek Manor Pharmacy

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

524 W 24th St
Ashtabula, OH 44004
Phone (440) 496-6500

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John M Ferretti Individual Corporate DirectorPresident Jan 7, 2008
Millcreek Manor Organization, Erie, PA Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 1989 100%
Silvia M Ferretti Individual Corporate DirectorVice President Jan 7, 2008
Joseph Kelly Individual Corporate DirectorBoard Member Jan 1, 2021
James Yi Lin Individual Corporate DirectorBoard Officer Mar 29, 2024
W-2 Managing EmployeePresident Mar 29, 2024
Joyce Savocchio Individual Corporate DirectorBoard Member Jan 7, 2008
Steven Inman Individual W-2 Managing EmployeeCfo Mar 1, 2025
Esther Fucci Individual Corporate DirectorBoard Member Jan 7, 2008
Mary L Eckert Individual Corporate DirectorSecretary Jan 7, 2008
Vincent S Fierro Individual Corporate DirectorBoard Member Jan 7, 2008

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1689489718",
    "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": "814-844-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16954 CONNEAUT LAKE RD",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353738",
            "telephone_number": "814-844-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK MANOR",
        "enumeration_date": "2025-02-07",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "LIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-602-7783"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Clinic of Meadville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.