Main Line Wellness LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAIN LINE WELLNESS LLC

Practice address

700 S Henderson Rd Ste 308C
King of Prussia, PA 19406-4206

Phone

(610) 337-3111

Fax

(610) 233-1272

NPI assigned

Oct 11, 2019

Organization subpart

Yes

Parent organization

ROY M LERMAN MD PCAs reported in NPPES

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

Authorized official

Name

Dr. Roy Lerman, MD

Title

Managing Partner

Phone

(610) 337-3111

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Part of

Roy M Lerman MD PC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Roy M Lerman MD PC

  • Physical Medicine & Rehabilitation Physician
  • King of Prussia, PA
  • NPI 1215030812
  NPPES parent name

Practitioners 2

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

• Lisa Anne McGovern, RN, FNP-C

  • Family Nurse Practitioner
  • King of Prussia, PA
  • NPI 1922843481
  NPD (past)
• Jordyn Wallace, CRNP

  • Family Nurse Practitioner
  • King of Prussia, PA
  • NPI 1538810734
  NPD (past)

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1093357923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S HENDERSON RD STE 308C",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194064206",
            "telephone_number": "610-337-3111",
            "fax_number": "610-233-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S HENDERSON RD STE 308C",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194064206",
            "telephone_number": "610-337-3111",
            "fax_number": "610-233-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROY M LERMAN MD PC",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "LERMAN",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "610-337-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STARTING CREDENTIALING PROCESS",
            "identifier": "1234567",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mainlinespine@comcast.net",
            "affiliation": "N",
            "address_1": "700 S Henderson Rd Ste 308C",
            "city": "King Of Prussia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "194064206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathleen Ann Mahony, BSN, RN FIRST ASSIST
• Allison Maier
• Main Line Plastic Surgery&Laser Associates
• Main Line Spine Surgery Center, LLC
• Main Line Vascular Institute LLC
• Bethany Maldonado
• Allison Maleski
• Bushra I Malik, MD
• Xhulia Maloku, BCBA
• Christine Maloney, MSN, CRNP

• Family Medicine Physician in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.