NPIMap

Organization Active NPI

Central PA Podiatry LLC

Doing business as Central PA Physicians Group

  • Podiatrist
  • Altoona, PA
National Provider Identifier
1841887494
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
CENTRAL PA PODIATRY LLC
Doing business as
Central PA Physicians Group
Practice address
914 S 12TH St
Altoona, PA 16602-6247
Phone
(814) 201-2309
Fax
(814) 201-2389
NPI assigned
Dec 30, 2020
Last updated
Dec 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRAL PA CARDIOLOGY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Denise Baranik
Title
Practice Manager
Phone
(814) 201-2309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

914 S 12TH St
Altoona, PA 16602-6247

Mailing address

914 S 12TH St
Altoona, PA 16602-6247
Phone (814) 201-2309

Other identifiers 3

IdentifierTypeStateIssuer
1487632428OtherPADR. DONALD MRDJENOVICH
1029762890001MedicaidPA
1902884950OtherPADR. GERALD GRONBORG

Other names 1

  • Central PA Physicians Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210323000269 PA Part B Supplier - Clinic/Group Practice 0446667224 Receives reassigned benefits from 8 practitioners
Practice locations: Altoona, PA; State College, PA; Roaring Spring, PA; Johnstown, PA; Everett, PA; Patton, PA

National Provider Directory

National Provider Directory
Part of
Central PA Cardiology

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1841887494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 S 12TH ST",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "166026247",
            "telephone_number": "814-201-2309",
            "fax_number": "814-201-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S 12TH ST",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "166026247",
            "telephone_number": "814-201-2309",
            "fax_number": "814-201-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PA PODIATRY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL PA CARDIOLOGY, LLC",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "BARANIK",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "814-201-2309"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. DONALD MRDJENOVICH",
            "identifier": "1487632428",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029762890001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. GERALD GRONBORG",
            "identifier": "1902884950",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central PA Physicians Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altoona, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.