NPIMap

Organization Active NPI

Denise Primavera D.C., P.C.

  • Chiropractor
  • Telford, PA
National Provider Identifier
1104987098
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC005445L Issued in PA
Legal business name
DENISE PRIMAVERA D.C., P.C.
Practice address
4019 Bethlehem Pike
Telford, PA 18969-1126
Phone
(215) 723-7900
Fax
(215) 723-4481
NPI assigned
Dec 13, 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
Dr. Denise L. Primavera, D.C.NPI 1831166883
Title
Chiropractor
Phone
(215) 723-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC005445L PA Primary

Addresses

Primary practice location

4019 Bethlehem Pike
Telford, PA 18969-1126

Mailing address

4019 Bethlehem Pike
Telford, PA 18969-1126
Phone (215) 723-7900

Other identifiers 4

IdentifierTypeStateIssuer
2012269000OtherPAIBC PROVIDER ID
2696603000OtherPAKEYSTONE GROUP ID
1256503OtherPAAETNA PROVIDER ID
S39676OtherPAAMERIHEALTH PROVIDER ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060508000884 PA Part B Supplier - Clinic/Group Practice 4789695586 Receives reassigned benefits from 3 practitioners
Practice locations: Telford, PA

National Provider Directory

National Provider Directory

Locations

4019 Bethlehem Pike
Telford, PA 18969
Phone (215) 480-0214

Practitioners & affiliated clinicians

Practitioners 5

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104987098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4019 BETHLEHEM PIKE",
            "city": "TELFORD",
            "state": "PA",
            "postal_code": "189691126",
            "telephone_number": "215-723-7900",
            "fax_number": "215-723-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4019 BETHLEHEM PIKE",
            "city": "TELFORD",
            "state": "PA",
            "postal_code": "189691126",
            "telephone_number": "215-723-7900",
            "fax_number": "215-723-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENISE PRIMAVERA D.C., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRIMAVERA",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "215-723-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC005445L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC PROVIDER ID",
            "identifier": "2012269000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE GROUP ID",
            "identifier": "2696603000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "1256503",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH PROVIDER ID",
            "identifier": "S39676",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Telford, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.