NPIMap

Organization Active NPI

Elk Regional Professional Group, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Saint Marys, PA
National Provider Identifier
1891782025
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
ELK REGIONAL PROFESSIONAL GROUP, INC
Practice address
763 Johnsonburg Rd
St Marys, PA 15857-3417
Phone
(814) 788-8179
Fax
(814) 788-8039
NPI assigned
Oct 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

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

Authorized official

Name
Jamie L Simbeck
Title
Business Adminsitrator
Phone
(814) 788-8615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

763 Johnsonburg Rd
St Marys, PA 15857-3417

Mailing address

763 Johnsonburg Rd
St Marys, PA 15857-3417
Phone (814) 788-8179

Other identifiers 2

IdentifierTypeStateIssuer
1430512OtherPAHIGHMARK ASSIGNMENT
0018592850037MedicaidPA

Other names 1

  • ERPG Pathology Services Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423000700 PA Part B Supplier - Clinic/Group Practice 4486553278 Receives reassigned benefits from 12 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kane, PA

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Elk Regional Professional Group Inc35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1891782025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 JOHNSONBURG RD",
            "city": "ST MARYS",
            "state": "PA",
            "postal_code": "158573417",
            "telephone_number": "814-788-8179",
            "fax_number": "814-788-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 JOHNSONBURG RD",
            "city": "ST MARYS",
            "state": "PA",
            "postal_code": "158573417",
            "telephone_number": "814-788-8179",
            "fax_number": "814-788-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK REGIONAL PROFESSIONAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "SIMBECK",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS ADMINSITRATOR",
        "authorized_official_telephone_number": "814-788-8615"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK ASSIGNMENT",
            "identifier": "1430512",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018592850037",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERPG Pathology Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Marys, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; 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.