NPIMap

Organization Active NPI

Integrated Medical Group

  • Gastroenterology Physician
  • Pottsville, PA
National Provider Identifier
1073577482
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
INTEGRATED MEDICAL GROUP
Practice address
48 Tunnel Rd
Suite 203
Pottsville, PA 17901-3875
Phone
(570) 622-5455
Fax
(570) 622-5493
NPI assigned
Apr 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
David Gonzalez
Title
Credentialing Contact
Phone
(570) 622-5455

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0100X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

48 Tunnel Rd
Suite 203
Pottsville, PA 17901-3875

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Integrated Medical Grou9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1073577482",
    "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": "48 TUNNEL RD",
            "address_2": "SUITE 203",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013875",
            "telephone_number": "570-622-5455",
            "fax_number": "570-622-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CREDENTIALING CONTACT",
        "authorized_official_telephone_number": "570-622-5455"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 11, 2008; 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.