NPIMap

Organization Active NPI

Medical Associates of Erie

Doing business as LECOM Institute for Behavioral Health

  • Psychiatry Physician
  • Erie, PA
National Provider Identifier
1790318988
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MEDICAL ASSOCIATES OF ERIE
Doing business as
LECOM Institute for Behavioral Health
Practice address
4740 Peach St
Erie, PA 16509-2008
Phone
(814) 520-5652
Fax
(814) 616-8002
NPI assigned
Feb 17, 2020
Last updated
Feb 19, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDICAL ASSOCIATES OF ERIEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Nicole Grossi
Title
Credentialing Specialist
Phone
(814) 868-2507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

4740 Peach St
Erie, PA 16509-2008

Mailing address

1 Lecom PL
Erie, PA 16505-2571
Phone (814) 868-2507

Other identifiers 1

IdentifierTypeStateIssuer
1010664580025MedicaidPA

Other names 1

  • LECOM Institute for Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Associates of Erie Inc36 organizations share this tax ID, including this one
Part of
Medical Associates of Erie Inc

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1790318988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LECOM PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052571",
            "telephone_number": "814-868-2507",
            "fax_number": "814-868-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092008",
            "telephone_number": "814-520-5652",
            "fax_number": "814-616-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF ERIE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL ASSOCIATES OF ERIE",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "GROSSI",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "814-868-2507"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010664580025",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Institute for Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.