Individual provider Active NPI

Deana Marie Bidey, D.O.

  • Child & Adolescent Psychiatry Physician
  • Marlton, NJ
National Provider Identifier
1053633164
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
OT012647 Issued in PA
Practice address
5000 Sagemore Dr Ste 205
Marlton, NJ 08053-4332
Phone
(856) 983-3866
NPI assigned
Feb 17, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X 25MB10854300 NJ
Child & Adolescent Psychiatry Physician 2084P0804X OT012647 PA Primary

Addresses

Primary practice location

5000 Sagemore Dr Ste 205
Marlton, NJ 08053-4332

Mailing address

324 Maple Ave
Haddonfield, NJ 08033-1436
Phone (570) 401-8743

Other practice location 1

420 Cowpath Rd
Souderton, PA 18964-2036
Phone (267) 203-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140825002099 PA Practitioner - Psychiatry 8729206214 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB10854300NJMDChild & Adolescent Psychiatry Physician
OT012647PAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. Single Specialty CurrentSince Jul 1, 2016 Accepting new patients
Prospect Health Access Network, Inc. Single Specialty CurrentSince Jul 1, 2016 Accepting new patients
Indian Creek Foundation Single Specialty CurrentSince Jan 1, 2023 Accepting new patients
Prospect Health Access Network, Inc. Single Specialty Current Accepting new patients

Locations

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

420 Cowpath Rd
Souderton, PA 18964
Phone (267) 203-1500

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1053633164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 MAPLE AVE",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080331436",
            "telephone_number": "570-401-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SAGEMORE DR STE 205",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534332",
            "telephone_number": "856-983-3866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Cowpath Rd",
            "address_purpose": "LOCATION",
            "city": "Souderton",
            "state": "PA",
            "postal_code": "189642036",
            "country_code": "US",
            "telephone_number": "267-203-1500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIDEY",
        "first_name": "DEANA",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-17",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MB10854300",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "OT012647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.