NPIMap

Individual provider Active NPI

Kathleen M Fernan, D.O.

  • Family Medicine Physician
  • Ridgway, PA
National Provider Identifier
1770584070
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS013170 Issued in PA
Practice address
200 South Mill Street
Ridgway, PA 15853
Phone
(814) 772-0722
Fax
(814) 772-6934
NPI assigned
Aug 9, 2005
Last updated
Sep 25, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS013170 PA Primary
General Practice Physician 208D00000X OS013170 PA

Addresses

Primary practice location

200 South Mill Street
Ridgway, PA 15853

Mailing address

200 South Mill Street
Ridgway, PA 15853
Phone (814) 772-0722

Other identifiers 3

IdentifierTypeStateIssuer
1833904OtherPAHIGHMARK
1016386070002MedicaidPA
1016386070001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050425000956 PA Practitioner - Family PracticePractitioner - General PracticePractitioner - Osteopathic Manipulative Medicine 5092754598 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice, Osteopathic Manipulative Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fernan Family PracticeGroup PAC ID 8022145671, 2 clinicians

Practice addresses (Care Compare)

200 S Mill Ave
Ridgway, PA 15853-2006
Phone (814) 772-0722

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Elk Regional Health Center, Inc. General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 33

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1770584070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SOUTH MILL STREET",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "15853",
            "telephone_number": "814-772-0722",
            "fax_number": "814-772-6934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOUTH MILL STREET",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "15853",
            "telephone_number": "814-772-0722",
            "fax_number": "814-772-6934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNAN",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS013170",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "OS013170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1833904",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016386070002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016386070001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgway, PA

Sources for this page

Verify at the official NPI Registry.