NPIMap

Organization Active NPI

Warren General Hospital

  • Diagnostic Radiology Physician
  • Warren, PA
National Provider Identifier
1811600307
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
WARREN GENERAL HOSPITAL
Practice address
2 W Crescent Park
Warren, PA 16365-2111
Phone
(814) 723-3300
Fax
(814) 723-8515
NPI assigned
Dec 30, 2022
Last updated
Jan 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Lisa M Ristau
Title
Patient Account Manager
Phone
(814) 723-4973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

2 W Crescent Park
Warren, PA 16365-2111

Mailing address

2 W Crescent Park
Warren, PA 16365-2111
Phone (814) 723-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, AZ, FL, MN, CA, HI, NV, OR, ID, WA, NC, TX, KY, OK, GA, CO, NE, MI, MD, LA, NJ, KS, SC, WV, VA, NM, IL, DC, MO, TN, MA, IA, AK, UT34 enrollments

Enrollment records 34

Enrollment IDStateProvider typePAC IDDetails
O20240119001134 PA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Downingtown, PA; Waverly, PA; Warren, PA; Philadelphia, PA; Newtown Square, PA; Maple Glen, PA; Newton Square, PA
O20241227002783 AZ Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 5 practitioners
Practice locations: Paradise Valley, AZ; Tempe, AZ; Scottsdale, AZ; Mesa, AZ; Gilbert, AZ
O20241231001799 FL Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 11 practitioners
Practice locations: Miami Beach, FL; Wellington, FL; Port Saint Lucie, FL; Palm Harbor, FL; Palm Beach Gardens, FL; Naples, FL; Milton, FL; Dunnellon, FL…
O20250103001224 MN Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Rochester, MN; Sartell, MN
O20250106000764 CA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 8 practitioners
Practice locations: Rancho Santa Fe, CA; El Granada, CA; Rancho Mirage, CA; Mill Valley, CA; Laguna Niguel, CA; Inglewood, CA; Half Moon Bay, CA; Dana Point, CA…
O20250107001807 HI Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Honolulu, HI; Kapolei, HI
O20250108001941 NV Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV
O20250109001885 OR Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 3 practitioners
Practice locations: Medford, OR; Eugene, OR
O20250109003441 ID Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Sandpoint, ID
O20250110003090 WA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 6 practitioners
Practice locations: Bellevue, WA; Fox Island, WA; Lake Forest Park, WA; Mercer Island, WA; Mukilteo, WA; Olympia, WA; Seattle, WA; Yarrow Point, WA
O20250114002786 NC Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 3 practitioners
Practice locations: Denver, NC; Lenoir, NC; Fayetteville, NC
O20250115002775 TX Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 6 practitioners
Practice locations: Garland, TX; Plano, TX; Leander, TX; Dallas, TX; Bellaire, TX; Fort Worth, TX
O20250116003009 KY Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY
O20250122000009 OK Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Stratford, OK; Sapulpa, OK
O20250125000024 GA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 5 practitioners
Practice locations: Savannah, GA; Peachtree City, GA; Marietta, GA; Atlanta, GA; Brookhaven, GA
O20250128001261 CO Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 6 practitioners
Practice locations: Carbondale, CO; Castle Rock, CO; Longmont, CO; Monument, CO; Superior, CO
O20250203001491 NE Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Bellevue, NE
O20250203001966 MI Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 4 practitioners
Practice locations: Cedar, MI; Traverse City, MI; Ypsilanti, MI
O20250203002475 MD Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Lutherville Timonium, MD
O20250203002803 LA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Baton Rouge, LA
O20250203003104 NJ Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Basking Ridge, NJ
O20250205001279 KS Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 3 practitioners
Practice locations: Hutchinson, KS; Wichita, KS
O20250205001627 SC Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Bluffton, SC
O20250206000324 WV Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Lewisburg, WV
O20250206001455 VA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 7 practitioners
Practice locations: Crozier, VA; Falls Church, VA; Henrico, VA; Richmond, VA; Virginia Beach, VA; Ashburn, VA
O20250210001291 NM Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Fe, NM
O20250225003159 IL Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Lincolnshire, IL
O20250306001812 DC Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Alexandria, VA; Washington, DC
O20250314001765 MO Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Joplin, MO; Kansas City, MO
O20250321001977 TN Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 3 practitioners
Practice locations: Lynnville, TN; Kingsport, TN; Athens, TN; Collierville, TN
O20260324000574 MA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Needham, MA; Orleans, MA
O20260403001242 IA Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 2 practitioners
Practice locations: Iowa City, IA; North Liberty, IA
O20260416003146 AK Part B Supplier - Clinic/Group Practice 4880501402 Practice locations: Anchorage, AK
O20260513004135 UT Part B Supplier - Clinic/Group Practice 4880501402 Receives reassigned benefits from 1 practitioner
Practice locations: Syracuse, UT

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mammogram Screenings Warren Gen Hosp17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Warren General HospitalWarren, PA, CCN 393458 Rural health clinic 5% Or Greater Direct Ownership Interest (55%) Sep 1, 2018
Warren General Hospital RHC Sugar GroveSugar Grove, PA, CCN 393456 Rural health clinic 5% Or Greater Direct Ownership Interest (55%) Sep 1, 2018
Warren General HospitalWarren, PA, CCN 393457 Rural health clinic 5% Or Greater Direct Ownership Interest (55%) Sep 1, 2018

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 109

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.

View all 109

NPI Registry JSON

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

{
    "created_epoch": "1672358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1811600307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 W CRESCENT PARK",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163652111",
            "telephone_number": "814-723-3300",
            "fax_number": "814-723-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W CRESCENT PARK",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163652111",
            "telephone_number": "814-723-3300",
            "fax_number": "814-723-8515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-30",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "RISTAU",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PATIENT ACCOUNT MANAGER",
        "authorized_official_telephone_number": "814-723-4973"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, PA

Sources for this page

Verify at the official NPI Registry.