Prospect Health Access Network, Inc.
Organization Active NPI Transplant Surgery Physician · Chester, PA
NPI 1013364538 · NPPES record last updated Jan 15, 2021
Key facts
- NPI
- 1013364538
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Transplant Surgery Physician 204F00000X
- Legal business name
- PROSPECT HEALTH ACCESS NETWORK, INC.
- Practice address
- 1 Medical Center Blvd
Pob II Suite 220
Chester, PA 19013-3902 - Phone
- (610) 619-8420
- Fax
- (610) 619-8421
- NPI assigned
- May 16, 2016
- Organization subpart
- No
Authorized official
- Name
- Robert Jon Elders
- Title
- Secretary
- Phone
- (714) 788-1249
Other NPIs on the same Medicare enrollment 25
Corporate family (same tax ID) 13
Practitioners 29
-
Jessica Adler, M.D.
-
Dorothy S Bloy, MD
-
Ryan Michael Bonshock, M.D.
-
Matthew F Cohen, MD
-
Sunny Leah Fink, M.D.
-
Darcy L. Hayes, MD
-
Marie Kamara, PMHNP
-
Alice Lee, DO
-
Humaira Mahbub, MD
-
Meaghan Lupinacci Reid, D.O.
-
Monika Rydzewska, MD
-
Armen M Sevag, DO
-
Shailee Viroja, D.O
-
Ashley S Von Dohlen, PA-C
-
Susan M Weil, MD
-
Rebecca L Avello, PA-C
-
Adam M Boise, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160613000737 | PA | Part B Supplier - Clinic/Group Practice | 5698065142 |
Receives reassigned benefits from 730 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Crozer Health Medical Group
Locations
501 N Lansdowne Ave
Ste 208
Drexel Hill, PA 19026
Phone (610) 447-6707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transplant Surgery Physician |
204F00000X | Yes |
Addresses
Primary practice location
1 Medical Center Blvd
Pob II Suite 220
Chester, PA 19013-3902
Mailing address
1 Medical Center Blvd
Pob II Suite 220
Chester, PA 19013-3902
Phone (610) 619-8420
Other names
- Kidney Transplant Center
NPI Registry JSON
{
"created_epoch": "1463356800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1610668800000",
"number": "1013364538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER BLVD",
"address_2": "POB II SUITE 220",
"city": "CHESTER",
"state": "PA",
"postal_code": "190133902",
"telephone_number": "610-619-8420",
"fax_number": "610-619-8421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER BLVD",
"address_2": "POB II SUITE 220",
"city": "CHESTER",
"state": "PA",
"postal_code": "190133902",
"telephone_number": "610-619-8420",
"fax_number": "610-619-8421"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROSPECT HEALTH ACCESS NETWORK, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2016-05-16",
"last_updated": "2021-01-15",
"certification_date": "2021-01-15",
"status": "A",
"authorized_official_last_name": "ELDERS",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "JON",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "714-788-1249"
},
"taxonomies": [
{
"code": "204F00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Transplant Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Kidney Transplant Center",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Kidney Transplant Center",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Chester, PA
- Prospect CCMC, LLC
- Prospect CCMC, LLC
- Prospect CCMC, LLC
- Prospect CCMC, LLC
- Prospect Health Access Network, Inc.
- Prospect Health Access Network, Inc.
- Prospect Health Access Network, Inc.
- Prospect Health Access Network, Inc.
- Prospect Health Access Network, Inc.
- Prospect Health Access Network, Inc.
All providers in Chester, PA · Transplant Surgery Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.