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MEADVILLE UROLOGY
NPI 1841782869
Urology in Meadville, PA

Active since June 05, 2018CLIA 39D2009809 · Waiver
765 LIBERTY ST STE 207A, MEADVILLE, PA 16335(814) 373-2156(814) 373-2159 Get Directions Write a Review

NPPES record last updated: August 8, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Meadville Urology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEADVILLE UROLOGY (NPI 1841782869) is a healthcare organization registered as an urology in Meadville, Pennsylvania and active in the NPI registry since June 2018. The organization holds a CLIA Waiver certificate valid through March 5, 2027 and lists Cory Frank Jackson, Controller, as its authorized official.

NPPES Registry Identity

NPI1841782869
Entity TypeOrganization
Primary Taxonomy208800000X
Legal Business NameMEADVILLE MEDICAL CENTER
Location Address765 LIBERTY ST STE 207AMeadville, PA 16335
Mailing Address1034 Grove StMeadville, PA 16335-2945 · (814) 373-3434 · Fax (814) 373-2159
Phone(814) 373-2156
Fax(814) 373-2159
Organization SubpartNo
Authorized OfficialCory Frank JacksonController · (814) 333-5766
Enumeration DateJune 5, 2018
Last NPPES UpdateAugust 8, 2018
✔ NPI 1841782869 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
765 LIBERTY ST STE 207A, Meadville, PA 16335
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Other Names 1

Doing Business AsMeadville Urology

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Meadville Urology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Meadville Urology, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Shane Daugherty
Urology
NPI 1154902096
765 LIBERTY ST STE 207A
Meadville, PA 16335
(814) 373-2156
✔ PECOS✔ Accepts MedicareSame address
Jessie Ganjoo, MD
Nephrology
NPI 1326015587
765 LIBERTY ST STE 307A
Meadville, PA 16335
(814) 333-3945
✔ PECOS✔ Accepts MedicareSame address
Michael Martynik, MD
Urology
NPI 1972519072
765 LIBERTY ST STE 207
Meadville, PA 16335
(814) 373-2156
✔ PECOS✔ Accepts MedicareSame address
Peter Lund, MD
Urology
NPI 1407881899
450 S WASHINGTON ST
Gettysburg, PA 17325
(717) 339-3150
✔ PECOS✔ Accepts Medicare198 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D2009809

Meadville Urology · Meadville, PA
Active · expires Mar 5, 2027
CLIA Number39D2009809
Laboratory TypePhysician Office
Certificate Effective DateMarch 6, 2025
Certificate Expiration DateMarch 5, 2027
Laboratory DirectorDr. Michael J. Martynik
Laboratory Phone(814) 373-2156
Laboratory LocationMeadville Urology765 Liberty Street, Suite 207, Meadville, PA 16335
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Meadville Medical Center's NPI number?

The NPI number for Meadville Medical Center is 1841782869. It was assigned to this organization in the NPPES registry on June 5, 2018. The provider is doing business as Meadville Urology.

Where is Meadville Medical Center located?

Meadville Medical Center is located at 765 Liberty St Ste 207A, Meadville, PA 16335. The listed phone number is (814) 373-2156.

What is Meadville Medical Center's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Meadville Medical Center enrolled in Medicare?

Yes. Meadville Medical Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Meadville Medical Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Meadville Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Urology (3) and Nephrology (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Meadville Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D2009809) is associated with this NPI, valid through March 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Meadville Medical Center was last updated on August 8, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.