Active NPI
Pedro Pena, MD
- Vascular & Interventional Radiology Physician
- Erie, PA
National Provider Identifier
1790784007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular & Interventional Radiology Physician
- License
- MD015257E
- Practice address
- 201 State St
Erie, PA 16550-0002 - Phone
- (814) 877-6182
- Fax
- (814) 877-6149
- NPI assigned
- Jul 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | MD015257E | PA | Primary |
Addresses
Primary practice location
201 State St
Erie, PA 16550-0002
Mailing address
201 State St
Erie, PA 16550-0002
Phone (814) 877-6182
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1068921 | Other | WV | W. VIRGINIA WORKERS COMP |
| 300120916 | Other | PA | RR MEDICARE |
| 00025445602 | Other | NY | UNIVERA |
| 1521688 | Other | PA | GATEWAY |
| 0018379020003 | Medicaid | PA | |
| 02146761 | Other | NY | NY MEDICAL ASSISTANCE |
| 2231365 | Other | OH | OH MEDICAL ASSISTANCE |
| 3369068 | Other | PA | AETNA |
| 304576 | Other | PA | UPMC |
| 118180 | Other | PA | UNISON |
| 722913 | Other | PA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368662400000",
"number": "1790784007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 STATE ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165500002",
"telephone_number": "814-877-6182",
"fax_number": "814-877-6149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 STATE ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165500002",
"telephone_number": "814-877-6182",
"fax_number": "814-877-6149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENA",
"first_name": "PEDRO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2013-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "PA",
"license": "MD015257E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "W. VIRGINIA WORKERS COMP",
"identifier": "1068921",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "300120916",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00025445602",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "1521688",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018379020003",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY MEDICAL ASSISTANCE",
"identifier": "02146761",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OH MEDICAL ASSISTANCE",
"identifier": "2231365",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3369068",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPMC",
"identifier": "304576",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "118180",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "722913",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}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 May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.