Basic Information
Provider Information | |||||||||
NPI: | 1538151899 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BATTISTELLA | ||||||||
FirstName: | GENE | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1000 BOWER HILL ROAD | ||||||||
Address2: | ATTN ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152431873 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4129422584 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 27 HECKEL RD STE 212 | ||||||||
Address2: |   | ||||||||
City: | MC KEES ROCKS | ||||||||
State: | PA | ||||||||
PostalCode: | 151361695 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4127774319 | ||||||||
FaxNumber: | 4127774390 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/22/2005 | ||||||||
LastUpdateDate: | 05/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS 008311L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 562437 | 01 |   | AETNA | OTHER | P000966 | 01 |   | GATEWAY HEALTH PLAN | OTHER | 110224602 | 01 |   | RAILROAD MEDICARE | OTHER | 000000099147 | 01 |   | UNISON HEALTH PLAN | OTHER | 0015785600002 | 05 | PA |   | MEDICAID | 251175 | 01 |   | UPMC HEALTH PLAN | OTHER | G43127 | 01 |   | HEALTH AMERICA | OTHER | 0967623000 | 01 | PA | INDEPENDENCE BLUE SHIELD | OTHER |