NPIMap

Organization Active NPI

Integrated Medical Group, P.C.

Doing business as IMG Podiatry

  • Podiatrist
  • Pottsville, PA
National Provider Identifier
1053695148
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
INTEGRATED MEDICAL GROUP, P.C.
Doing business as
IMG Podiatry
Practice address
1626 Mount Hope Ave
Pottsville, PA 17901-1302
Phone
(570) 622-2230
Fax
(570) 622-5724
NPI assigned
Oct 6, 2011
Last updated
Oct 6, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRATED MEDICAL GROUP, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Authorized official

Name
Joseph C Pillus
Title
Chief Executive Officer
Phone
(570) 622-5455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

1626 Mount Hope Ave
Pottsville, PA 17901-1302

Mailing address

48 Tunnel Rd
Suite 203
Pottsville, PA 17901-3875
Phone (570) 622-5455

Other names 1

  • IMG Podiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120504000103 PA DME Supplier - Physician - Podiatry 1355247180 Practice locations: Pottsville, PA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Img PT9 organizations share this tax ID, including this one
Part of
Img PT

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1053695148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 TUNNEL RD",
            "address_2": "SUITE 203",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013875",
            "telephone_number": "570-622-5455",
            "fax_number": "570-622-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 MOUNT HOPE AVE",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179011302",
            "telephone_number": "570-622-2230",
            "fax_number": "570-622-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATED MEDICAL GROUP, P.C.",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "PILLUS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "570-622-5455"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMG Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.