Organization Active NPI

Excela Health Physician Practices, Inc.

Doing business as Excela Health Med Group Family Medicine - Latrobe

  • Family Medicine Physician
  • Latrobe, PA
National Provider Identifier
1811326978
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EXCELA HEALTH PHYSICIAN PRACTICES, INC.
Doing business as
Excela Health Med Group Family Medicine - Latrobe
Practice address
1 Mellon Way
Latrobe, PA 15650-1197
Phone
(724) 537-1435
Fax
(724) 537-1437
NPI assigned
Nov 8, 2013
Last updated
Nov 8, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
EXCELA HEALTH HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Authorized official

Name
Melissa L. Dishong
Title
Vice President/Executive Director
Phone
(724) 830-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1 Mellon Way
Latrobe, PA 15650-1197

Mailing address

134 Industrial Park Rd
Ste 2300a
Greensburg, PA 15601-7328
Phone (724) 689-1835

Other identifiers 1

IdentifierTypeStateIssuer
001562186MedicaidPA

Other names 1

  • Excela Health Med Group Family Medicine - Latrobe 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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1811326978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INDUSTRIAL PARK RD",
            "address_2": "STE 2300A",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156017328",
            "telephone_number": "724-689-1835",
            "fax_number": "724-850-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MELLON WAY",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156501197",
            "telephone_number": "724-537-1435",
            "fax_number": "724-537-1437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELA HEALTH PHYSICIAN PRACTICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXCELA HEALTH HOLDING COMPANY",
        "enumeration_date": "2013-11-08",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "DISHONG",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-830-8500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001562186",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excela Health Med Group Family Medicine - Latrobe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Latrobe, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.