NPIMap

Organization Active NPI

Trinity Health Mid-Atlantic Medical Group

Doing business as The Bariatric and Metabolic Surgery Program at St.Mary Medical Center

  • Obesity Medicine (Internal Medicine) Physician
  • Langhorne, PA
National Provider Identifier
1003176488
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X
Legal business name
TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Doing business as
The Bariatric and Metabolic Surgery Program at St.Mary Medical Center
Practice address
1205 Langhrn Nwtwn Rd Ste 310
Langhorne, PA 19047
Phone
(215) 710-5711
Fax
(215) 710-5925
NPI assigned
May 21, 2012
Last updated
Dec 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

Name
Sharon Profera
Title
Admin Dir of Financial Services
Phone
(215) 710-2013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Internal Medicine) Physician 207RB0002X NU Primary

Addresses

Primary practice location

1205 Langhrn Nwtwn Rd Ste 310
Langhorne, PA 19047

Mailing address

41 University Dr Ste 300
Newtown, PA 18940-1873
Phone (201) 710-5522

Other names 1

  • The Bariatric and Metabolic Surgery Program at St.Mary Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000613 PA Part B Supplier - Clinic/Group Practice 7416861885 Receives reassigned benefits from 703 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1003176488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 UNIVERSITY DR STE 300",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189401873",
            "telephone_number": "201-710-5522",
            "fax_number": "215-710-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 LANGHRN NWTWN RD STE 310",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "19047",
            "telephone_number": "215-710-5711",
            "fax_number": "215-710-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "PROFERA",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "ADMIN DIR OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "215-710-2013"
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Bariatric and Metabolic Surgery Program at St.Mary Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Bariatric and Metabolic Surgery Program at St.Mary Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Langhorne, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.