NPIMap

Organization Active NPI

Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Erie, PA
National Provider Identifier
1982971503
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
Legal business name
SHRINERS HOSPITALS FOR CHILDREN
Practice address
1645 W 8TH St
Erie, PA 16505-5007
Phone
(814) 875-8700
Fax
(814) 875-8756
NPI assigned
Nov 28, 2011
Organization subpart
Yes
Parent organization
SHRINERS HOSPITALS FOR CHILDRENAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Authorized official

Name
Jerry G. Gantt
Title
President, Shriners Hospitals for C
Phone
(813) 281-0300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Pediatric Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XP3100X Primary

Addresses

Primary practice location

1645 W 8TH St
Erie, PA 16505-5007

Mailing address

PO Box 8500
Lockbox #7642
Philadelphia, PA 19178-7642
Phone (813) 281-8478

Other names 1

  • Shriners Hospitals for Children Professional Services - Erie Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121012000051 PA Part B Supplier - Clinic/Group Practice 9133031933 Receives reassigned benefits from 33 practitioners
3 other NPIs on this enrollment
Practice locations: Erie, PA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Shriners Hosp for Children

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shriners Hospitals for ChildrenPhiladelphia, PA, CCN 393309 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 24, 1966
Jun 24, 1966
Shriners Hospitals for ChildrenPortland, OR, CCN 383300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 15, 1966
Jan 15, 2015
Shriners Hospitals for ChildrenGalveston, TX, CCN 453311 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 1966
Mar 20, 1966
Shriners Hospitals for ChildrenHonolulu, HI, CCN 123301 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2013
Oct 1, 2013
Shriners Hospitals for ChildrenSacramento, CA, CCN 053311 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 15, 1997
Apr 15, 1997
Shriners Hospitals for ChildrenGreenville, SC, CCN 423300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 20, 2013
Jul 15, 2010
Shriners Children'S OhioDayton, OH, CCN 363308 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 19, 1968
Feb 19, 1968
Shriners Hospitals for ChildrenChicago, IL, CCN 143302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966
Shriners Hospitals for ChildrenSaint Louis, MO, CCN 263304 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1982971503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500",
            "address_2": "LOCKBOX #7642",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191787642",
            "telephone_number": "813-281-8478",
            "fax_number": "813-281-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-875-8700",
            "fax_number": "814-875-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "enumeration_date": "2011-11-28",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "GANTT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT, SHRINERS HOSPITALS FOR C",
        "authorized_official_telephone_number": "813-281-0300"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shriners Hospitals for Children Professional Services - Erie",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.