NPIMap

Organization Active NPI

Clearfield Professional Group, LTD.

  • Internal Medicine Physician
  • Clearfield, PA
National Provider Identifier
1730108994
Registry record updated Jan 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CLEARFIELD PROFESSIONAL GROUP, LTD.
Practice address
820 Turnpike Ave
Clearfield, PA 16830-1229
Phone
(814) 765-2412
Fax
(814) 765-8807
NPI assigned
Jul 19, 2006
Last updated
Jan 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2014

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

Authorized official

Name
Mr. Brian Blair Witherow
Title
Business Manager
Phone
(814) 765-5796

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
Pulmonary Disease Physician 207RP1001X

Addresses

Primary practice location

820 Turnpike Ave
Clearfield, PA 16830-1229

Mailing address

820 Turnpike Ave
Clearfield, PA 16830-1229
Phone (814) 765-2412

Other identifiers 1

IdentifierTypeStateIssuer
0011097860011MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000535 PA Part B Supplier - Clinic/Group Practice 7214827914 Receives reassigned benefits from 4 practitioners
Practice locations: Clearfield, PA

National Provider Directory

National Provider Directory

Locations

820 Turnpike Ave
Clearfield, PA 16830
Phone (814) 765-2006

Practitioners & affiliated clinicians

Practitioners 11

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": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1730108994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 TURNPIKE AVE",
            "city": "CLEARFIELD",
            "state": "PA",
            "postal_code": "168301229",
            "telephone_number": "814-765-2412",
            "fax_number": "814-765-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 TURNPIKE AVE",
            "city": "CLEARFIELD",
            "state": "PA",
            "postal_code": "168301229",
            "telephone_number": "814-765-2412",
            "fax_number": "814-765-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARFIELD PROFESSIONAL GROUP, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "WITHEROW",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "BLAIR",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "814-765-5796",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011097860011",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearfield, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.