NPIMap

Organization Active NPI

Commonwealth Clinical Group, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Exton, PA
National Provider Identifier
1013530898
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
COMMONWEALTH CLINICAL GROUP, INC.
Practice address
479 Thomas Jones Way Ste 100
Exton, PA 19341-2585
Phone
(484) 879-6751
Fax
(484) 879-6759
NPI assigned
May 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Authorized official

Name
Stacie Basham
Title
Billing Coordinator
Phone
(717) 393-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

479 Thomas Jones Way Ste 100
Exton, PA 19341-2585

Mailing address

41 E Orange St
Lancaster, PA 17602-2846
Phone (717) 393-3900

Other identifiers 1

IdentifierTypeStateIssuer
146330MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL central.referral@ccgtherapy.com

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth Clinical Group Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1013530898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E ORANGE ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022846",
            "telephone_number": "717-393-3900",
            "fax_number": "717-393-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "479 THOMAS JONES WAY STE 100",
            "city": "EXTON",
            "state": "PA",
            "postal_code": "193412585",
            "telephone_number": "484-879-6751",
            "fax_number": "484-879-6759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH CLINICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "BASHAM",
        "authorized_official_first_name": "STACIE",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "717-393-3900"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146330",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "central.referral@ccgtherapy.com",
            "affiliation": "N",
            "address_1": "479 Thomas Jones Way Ste 100",
            "city": "Exton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "193412585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Exton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.