NPIMap

Organization Active NPI

Elk Regional Professional Group, Inc.

  • Emergency Medicine Physician
  • Saint Marys, PA
National Provider Identifier
1912994138
Registry record updated Sep 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ELK REGIONAL PROFESSIONAL GROUP, INC.
Practice address
763 Johnsonburg Rd
St Marys, PA 15857-3417
Phone
(814) 788-8595
Fax
(814) 788-8036
NPI assigned
Oct 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

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

Authorized official

Name
Jamie L Simbeck
Title
Business Administrator
Phone
(814) 788-8580

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

763 Johnsonburg Rd
St Marys, PA 15857-3417

Mailing address

763 Johnsonburg Rd
St Marys, PA 15857-3417
Phone (814) 788-8595

Other identifiers 2

IdentifierTypeStateIssuer
0018592850036MedicaidPA
1313054OtherPAHIGHMARK ASSIGNMENT

Other names 1

  • ERPG Emergency 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": "1378166400000",
    "number": "1912994138",
    "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": "814-788-8595",
            "fax_number": "814-788-8036"
        },
        {
            "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": "814-788-8595",
            "fax_number": "814-788-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK REGIONAL PROFESSIONAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "SIMBECK",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "814-788-8580"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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": "0018592850036",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK ASSIGNMENT",
            "identifier": "1313054",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERPG Emergency 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 3, 2013; 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.