NPIMap

Organization Active NPI

Excela Health Physician Practices, Inc.

Doing business as Excela Square Latrobe Family Medicine

  • Family Medicine Physician
  • Latrobe, PA
National Provider Identifier
1831654391
Registry record updated Feb 8, 2019
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 Square Latrobe Family Medicine
Practice address
100 Excela Health Dr Ste 301
Latrobe, PA 15650-9001
Phone
(724) 537-1480
Fax
(724) 539-6353
NPI assigned
Feb 8, 2019
Last updated
Feb 8, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
EXCELA HEALTH HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 8, 2019

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

Authorized official

Name
Renee M Varney
Title
Credentialing Coordinator
Phone
(724) 850-6933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

100 Excela Health Dr Ste 301
Latrobe, PA 15650-9001

Mailing address

134 Industrial Park Rd Ste 1500
Greensburg, PA 15601-8153
Phone (724) 850-6933

Other names 1

  • Excela Square Latrobe Family Medicine 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

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

100 Excela Health Dr
#301
Latrobe, PA 15650

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549584000000",
    "number": "1831654391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INDUSTRIAL PARK RD STE 1500",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156018153",
            "telephone_number": "724-850-6933",
            "fax_number": "724-522-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXCELA HEALTH DR STE 301",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156509001",
            "telephone_number": "724-537-1480",
            "fax_number": "724-539-6353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELA HEALTH PHYSICIAN PRACTICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXCELA HEALTH HOLDING COMPANY",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A",
        "authorized_official_last_name": "VARNEY",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "724-850-6933"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excela Square Latrobe Family Medicine",
            "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 Feb 8, 2019; 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.