Port Allegany Area Family Practice PC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PORT ALLEGANY AREA FAMILY PRACTICE PC

Doing business as

Upper Allegheny Medical Center

Practice address

1 Willow St
Port Allegany, PA 16743-1332

Phone

(814) 642-9531

Fax

(814) 642-2020

NPI assigned

Apr 27, 2006

Last updated

Jun 22, 2022By 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

Mark H Shelley, M.D.NPI 1336106954

Title

President

Phone

(814) 642-9531

Specialties & licenses 5

Addresses

Other names 1

• UPPER ALLEGHENY MEDICAL CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962469486. Details of each certification follow.

• CCN 393849 Rural health clinic · Active · Details

Rural health clinic certification: CCN 393849

Legal name

PORT ALLEGANY AREA FAMILY PRACTICE PC

Doing business as

UPPER ALLEGHENY MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 17, 1992

Last certification

Nov 8, 2021

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Nov 1, 1980 in PA

Enrollment address

1 Willow St
Upper Allegheny Medical Center
Port Allegany, PA 16743-1332

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Mark H Shelley, M.D.

  • Family Medicine Physician
  • Port Allegany, PA
  • NPI 1336106954

  Corporate Director

  CMS ownership

Practitioners 4

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.

• Mark H Shelley, M.D.

  • Family Medicine Physician
  • Port Allegany, PA
  • NPI 1336106954
  Medicare reassignment Care Compare group NPD Authorized official
• Heather Deimler Kio, CRNP

  • Family Nurse Practitioner
  • Port Allegany, PA
  • NPI 1821724139
  Medicare reassignment Care Compare group NPD
• Mary C Schimp, PA-C

  • Physician Assistant
  • Emporium, PA
  • NPI 1083991814
  Medicare reassignment Care Compare group
• Megan Marie Borger, PA-C

  • Medical Physician Assistant
  • New Castle, PA
  • NPI 1053563718
  Medicare reassignment

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1962469486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WILLOW ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431332",
            "telephone_number": "814-642-9531",
            "fax_number": "814-642-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WILLOW ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431332",
            "telephone_number": "814-642-9531",
            "fax_number": "814-642-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ALLEGANY AREA FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-642-9531",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD029656E",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA053689",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP008214",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP009929",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPPER ALLEGHENY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UPPER ALLEGHENY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacob Middaugh, PHARM. D
• Jesse D Minor, CRNP
• Jennifer A Morrison, LCSW
• Newtko Inc (Port Allegany Pharmacy)
• Olean Medical Group Partnership
• Port Allegany Chiropractic LLC
• Port Aqllegany Pharmacy
• Port Area Ambulance Service, Inc.
• Rite Aid of Pennsylvania LLC (Rite Aid Pharmacy 02474)
• Sagewood, Inc.

• Rural Health Clinic/Center in Port Allegany, PA
• Providers in Port Allegany, PA by specialty
• Rural Health Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.