NPIMap

Organization Active NPI

Excela Health Physician Practices, Inc

Doing business as Excela Square at Latrobe Primary Care

  • Family Medicine Physician
  • Latrobe, PA
National Provider Identifier
1942713409
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EXCELA HEALTH PHYSICIAN PRACTICES, INC
Doing business as
Excela Square at Latrobe Primary Care
Practice address
100 Excela Health Drive
Latrobe, PA 15650
Phone
(724) 804-1725
Fax
(724) 804-1727
NPI assigned
Nov 7, 2017
Last updated
Feb 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
EXCELA HEALTH HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Authorized official

Name
Renee M Varney
Title
Lead Credentialing Coordinator
Phone
(724) 850-6933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

100 Excela Health Drive
Latrobe, PA 15650

Mailing address

134 Industrial Park Rd Ste 1500
Greensburg, PA 15601-8153
Phone (724) 850-6933

Other names 1

  • Excela Square at Latrobe Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322001393 PA Part B Supplier - Clinic/Group Practice 6204737117 Receives reassigned benefits from 767 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
West Primary HLTH Ctr D42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Locations

540 South St
Ste 301
Greensburg, PA 15601
Phone (724) 261-5610

100 Excela Health Dr
Ste 201
Latrobe, PA 15650
Phone (724) 804-1725

Practitioners & affiliated clinicians

Practitioners 8

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": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1942713409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 INDUSTRIAL PARK RD STE 1500",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156018153",
            "telephone_number": "724-850-6933",
            "fax_number": "724-522-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXCELA HEALTH DRIVE",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "15650",
            "telephone_number": "724-804-1725",
            "fax_number": "724-804-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELA HEALTH PHYSICIAN PRACTICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXCELA HEALTH HOLDING COMPANY",
        "enumeration_date": "2017-11-07",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "VARNEY",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LEAD CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "724-850-6933"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excela Square at Latrobe Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Latrobe, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.