NPIMap

Organization Active NPI

Greene County Primary Care, PC

  • Internal Medicine Physician
  • Waynesburg, PA
National Provider Identifier
1972532109
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD418743 Issued in PA
Legal business name
GREENE COUNTY PRIMARY CARE, PC
Practice address
430 E Oakview Dr
Suite a
Waynesburg, PA 15370-9729
Phone
(724) 627-8582
Fax
(724) 627-7756
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Jami D Boris, MD
Title
President
Phone
(724) 627-8582

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MD418743 PA Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD418743 PA

Addresses

Primary practice location

430 E Oakview Dr
Suite a
Waynesburg, PA 15370-9729

Mailing address

430 E Oakview Dr
Suite a
Waynesburg, PA 15370-9729
Phone (724) 627-8582

Other identifiers 4

IdentifierTypeStateIssuer
0019036410001MedicaidPA
538628OtherPAAETNA
1393789OtherPABCBS
1528302OtherPAGATEWAY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1972532109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E OAKVIEW DR",
            "address_2": "SUITE A",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153709729",
            "telephone_number": "724-627-8582",
            "fax_number": "724-627-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E OAKVIEW DR",
            "address_2": "SUITE A",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153709729",
            "telephone_number": "724-627-8582",
            "fax_number": "724-627-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE COUNTY PRIMARY CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BORIS",
        "authorized_official_first_name": "JAMI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-627-8582",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD418743",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD418743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019036410001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "538628",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1393789",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1528302",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.