Active NPI
Christian Rea
- Prevention Professional
- Brodheadsville, PA
National Provider Identifier
1013455583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- TE1003877
- Practice address
- 120 Burrus Blvd Ste 130
Brodheadsville, PA 18322-7812 - Phone
- (570) 992-4400
- NPI assigned
- Feb 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | TE1003877 | PA | Primary |
Addresses
Primary practice location
120 Burrus Blvd Ste 130
Brodheadsville, PA 18322-7812
Mailing address
120 Burrus Blvd Ste 130
Brodheadsville, PA 18322-7812
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE1003877 | PA | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1013455583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 BURRUS BLVD STE 130",
"city": "BRODHEADSVILLE",
"state": "PA",
"postal_code": "183227812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BURRUS BLVD STE 130",
"city": "BRODHEADSVILLE",
"state": "PA",
"postal_code": "183227812",
"telephone_number": "570-992-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REA",
"first_name": "CHRISTIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-06",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "PA",
"license": "TE1003877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brodheadsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.