Organization Active NPI

Perry Physicians, P.C.

  • Family Medicine Physician
  • Shermans Dale, PA
National Provider Identifier
1013920776
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PERRY PHYSICIANS, P.C.
Practice address
4570 Valley Rd
Shermans Dale, PA 17090
Phone
(717) 582-2090
Fax
(717) 582-7090
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jacqueline Bingaman
Title
Office Manager
Phone
(717) 582-2090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X PA Primary

Addresses

Primary practice location

4570 Valley Rd
Shermans Dale, PA 17090

Mailing address

PO Box 276
Shermans Dale, PA 17090-0276
Phone (717) 582-2090

Other identifiers 2

IdentifierTypeStateIssuer
1009420110001MedicaidPA
50026520OtherPACAPITAL BLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401001379 PA Part B Supplier - Clinic/Group Practice 5799777322 Receives reassigned benefits from 2 practitioners
Practice locations: Shermans Dale, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1021953Perry Physicians PC4570 Valley Road, Shermansdale, PA 17090Provider-performed microscopyFeb 3, 2028

National Provider Directory

National Provider Directory

Locations

4570 Valley Rd
Shermans Dale, PA 17090
Phone (717) 385-1475

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013920776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 276",
            "city": "SHERMANS DALE",
            "state": "PA",
            "postal_code": "170900276",
            "telephone_number": "717-582-2090",
            "fax_number": "717-582-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 VALLEY RD",
            "city": "SHERMANS DALE",
            "state": "PA",
            "postal_code": "17090",
            "telephone_number": "717-582-2090",
            "fax_number": "717-582-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY PHYSICIANS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BINGAMAN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "717-582-2090"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009420110001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50026520",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shermans Dale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.