NPIMap

Organization Active NPI

Dubois Regional Medical Center - Penn Highlands Dubois East Campus

  • Infectious Disease Physician
  • Du Bois, PA
National Provider Identifier
1851776397
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
DUBOIS REGIONAL MEDICAL CENTER - PENN HIGHLANDS DUBOIS EAST CAMPUS
Practice address
635 Maple Ave
Du Bois, PA 15801-2376
Phone
(814) 371-2200
Fax
(814) 375-4232
NPI assigned
Jul 27, 2015
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Authorized official

Name
Brian Kline
Title
Cfo
Phone
(814) 375-6377

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0500X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

635 Maple Ave
Du Bois, PA 15801-2376

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 371-2200

Other identifiers 1

IdentifierTypeStateIssuer
1007740880070MedicaidPA

Other names 1

  • Penn Highlands DuBois Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Patrick Shilala123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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.

NPI Registry JSON

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1851776397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-371-2200",
            "fax_number": "814-375-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 MAPLE AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012376",
            "telephone_number": "814-371-2200",
            "fax_number": "814-375-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS REGIONAL MEDICAL CENTER - PENN HIGHLANDS DUBOIS EAST CAMPUS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2015-07-27",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-375-6377"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007740880070",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Highlands DuBois",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Penn Highlands DuBois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Du Bois, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.