NPIMap

Organization Active NPI

Excela Health Physician Practices, Inc.

Doing business as Excela Health Youngwood Internal Medicine

  • Internal Medicine Physician
  • Youngwood, PA
National Provider Identifier
1750477907
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Doing business as
Excela Health Youngwood Internal Medicine
Practice address
505 N 4TH St
Youngwood, PA 15697-1558
Phone
(724) 925-1211
Fax
(724) 925-2931
NPI assigned
Oct 5, 2006
Last updated
Feb 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
EXCELA HEALTH HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Authorized official

Name
Renee M Varney
Title
Credentialing Coordinator
Phone
(724) 850-6933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

505 N 4TH St
Youngwood, PA 15697-1558

Mailing address

134 Industrial Park Rd Ste 1500
Greensburg, PA 15601-8153
Phone (724) 850-6933

Other identifiers 1

IdentifierTypeStateIssuer
535978OtherMEDICARE GRP. NO.

Other names 1

  • Excela Health Youngwood Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322001393 PA Part B Supplier - Clinic/Group Practice 6204737117 Receives reassigned benefits from 767 practitioners
This NPI is an additional NPI on the enrollment

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
39D0181383Excela Health Youngwood Internal Medicine505 North 4TH Street, Youngwood, PA 15697Certificate of waiverNov 11, 2027

National Provider Directory

National Provider Directory

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1750477907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INDUSTRIAL PARK RD STE 1500",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156018153",
            "telephone_number": "724-850-6933",
            "fax_number": "724-522-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N 4TH ST",
            "city": "YOUNGWOOD",
            "state": "PA",
            "postal_code": "156971558",
            "telephone_number": "724-925-1211",
            "fax_number": "724-925-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELA HEALTH PHYSICIAN PRACTICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXCELA HEALTH HOLDING COMPANY",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "VARNEY",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "724-850-6933"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP. NO.",
            "identifier": "535978",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excela Health Youngwood Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Excela Health Youngwood Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Youngwood, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.

Verify at the official NPI Registry.