NPIMap

Organization Active NPI

Dubois Regional Medical Center

Doing business as Penn Highlands Concussion Clinic

  • Sports Medicine (Family Medicine) Physician
  • Du Bois, PA
National Provider Identifier
1780125062
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
DUBOIS REGIONAL MEDICAL CENTER
Doing business as
Penn Highlands Concussion Clinic
Practice address
145 Hospital Ave
Suite 312
Du Bois, PA 15801-1462
Phone
(814) 375-6200
NPI assigned
Mar 20, 2017
Last updated
Apr 5, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Authorized official

Name
Brian S Kline
Title
VP/Cfo/Authorized Official
Phone
(814) 375-6377

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PA
Sports Medicine (Family Medicine) Physician 207QS0010X NU Primary

Addresses

Primary practice location

145 Hospital Ave
Suite 312
Du Bois, PA 15801-1462

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-6560

Other identifiers 1

IdentifierTypeStateIssuer
100774088MedicaidPA

Other names 1

  • Penn Highlands Concussion Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dubois Regional Medical Center - Penn Highlands Dubois Medical Arts123 organizations share this tax ID, including this one
Part of
Penn Highlands Healthcare

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1780125062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-375-6560",
            "fax_number": "814-372-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE",
            "address_2": "SUITE 312",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011462",
            "telephone_number": "814-375-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2017-03-20",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VP/CFO/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "814-375-6377"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100774088",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Highlands Concussion Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Du Bois, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.