Thomas R. Ellenberger, Jr MD PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

MD018414E Issued in PA

Legal business name

THOMAS R. ELLENBERGER, JR MD PC

Practice address

321 Main St Ste 5D
Johnstown, PA 15901-1632

Phone

(814) 535-7885

Fax

(814) 535-7079

NPI assigned

Mar 20, 2007

Last updated

Sep 27, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Richard Ellenberger Jr., M.D.NPI 1508818410

Title

President

Phone

(814) 535-7885

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

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.

• Thomas Richard Ellenberger Jr., M.D.

  • Internal Medicine Physician
  • Johnstown, PA
  • NPI 1508818410
  Authorized official Same address or phone

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1942325592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 MAIN ST STE 5D",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011632",
            "telephone_number": "814-535-7885",
            "fax_number": "814-535-7079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 MAIN ST STE 5D",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011632",
            "telephone_number": "814-535-7885",
            "fax_number": "814-535-7079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS R. ELLENBERGER, JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "ELLENBERGER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-535-7885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "PA",
            "license": "MD018414E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "027796",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006378450001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC HEALTH PLAN",
            "identifier": "11978",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "0743755",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Villa Assisted Living, LLC
• The Villa House, LLC
• The Villa House, LLC
• The Villages of Hilltop Heights, LLC
• The Willowbrook Center
• Bernice Thomas
• Dale Russell Thomas Jr., LCSW
• Denise Thomas, RN
• Erin Thomas, PHARMD
• Michele L. Thomas, LPC

• Medical Specialty Clinic/Center in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Medical Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; 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.