Concordia Physician Practice
Organization Active NPI Family Medicine Physician · Cabot, PA
NPI 1699153247 · NPPES record last updated May 15, 2015
Key facts
- NPI
- 1699153247
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CONCORDIA PHYSICIAN PRACTICE
- Practice address
- 112 Marwood Road #5000
Cabot, PA 16023-2245 - Phone
- (724) 352-4448
- Fax
- (724) 352-4412
- NPI assigned
- May 15, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- CONCORDIA LUTHERAN MINISTRIES
Authorized official
- Name
- Mr. Keith E Frndak
- Title
- Chief Executive Officer
- Phone
- (724) 352-1571
Practitioners 14
-
Daniel Patrick McKnight, CRNP
-
Marc H Oster, MD
-
Grant J Shevchik, MD
-
Stephanie Marie Snow, CRNP
-
Terrance Shelton, CRNP
-
Benjamin L Kisslinger, M.D.
-
Elaine Rea, CRNP
-
Michael M. Rowe, DO
-
Bhanu Sree Alapati, M.D.
-
Jennifer Rebecca Rickman, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D1029545 | Concordia Physician Practice | Certificate of waiver | Aug 17, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150713000320 | PA | Part B Supplier - Clinic/Group Practice | 8820300387 |
Receives reassigned benefits from 7 practitioners Practice locations: Cabot, PA |
National Provider Directory
Locations
112 Marwood Rd
Ste 5000
Cabot, PA 16023
Phone (724) 352-4448
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
112 Marwood Road #5000
Cabot, PA 16023-2245
Mailing address
112 Marwood Road #5000
Cabot, PA 16023-2245
Phone (724) 352-4448
Other providers in Cabot, PA
- Amber Bowser
- Bravis Enterprises, Inc
- Concordia Lutheran Health and Human Care
- Concordia Lutheran Health and Human Care
- Concordia Medical Equipment
- Concordia Telecaregivers Dba Concordia Private Care
- Concordia Visiting Nurses
- Craig Taylor, MD PC
- Cara Degrano
- Alexander Deyoung
All providers in Cabot, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2015. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.