Active NPI
Excela Health Physician Practices, Inc.
- Family Medicine Physician
- Herminie, PA
National Provider Identifier
1831476282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- EXCELA HEALTH PHYSICIAN PRACTICES, INC.
- Doing business as
- Excela Health Herminie Family Medicine
- Practice address
- 401 Church St
Herminie, PA 15637-1457 - Phone
- (724) 446-5571
- Fax
- (724) 446-2151
- NPI assigned
- Nov 14, 2011
- Organization subpart
- Yes
- Parent organization
- EXCELA HEALTH HOLDING COMPANY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kirk L Miller
- Title
- VP, Phys Serv & Exec Dir, Ehpp
- Phone
- (724) 830-8500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
401 Church St
Herminie, PA 15637-1457
Mailing address
134 Industrial Park Rd
Suite 2300a
Greensburg, PA 15601-7328
Phone (724) 689-1810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001562186 | Medicaid | PA |
Other names 1
- Excela Health Herminie Family Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321228800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1321228800000",
"number": "1831476282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 INDUSTRIAL PARK RD",
"address_2": "SUITE 2300A",
"city": "GREENSBURG",
"state": "PA",
"postal_code": "156017328",
"telephone_number": "724-689-1810",
"fax_number": "724-850-8096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 CHURCH ST",
"city": "HERMINIE",
"state": "PA",
"postal_code": "156371457",
"telephone_number": "724-446-5571",
"fax_number": "724-446-2151"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EXCELA HEALTH PHYSICIAN PRACTICES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EXCELA HEALTH HOLDING COMPANY",
"enumeration_date": "2011-11-14",
"last_updated": "2011-11-14",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "KIRK",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "VP, PHYS SERV & EXEC DIR, EHPP",
"authorized_official_telephone_number": "724-830-8500"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY 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 Herminie Family Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Herminie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.