NPIMap

Organization Active NPI

Pmsi Division of Pulmonary

  • Pulmonary Disease Physician
  • Pottstown, PA
National Provider Identifier
1114042595
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
OS006542L Issued in NU
Legal business name
PMSI DIVISION OF PULMONARY
Practice address
1591 Medical Drive
Pottstown, PA 19464
Phone
(610) 326-8005
Fax
(484) 945-0572
NPI assigned
Mar 21, 2007
Last updated
Jul 14, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
POTTSTOWN MEDICAL SPECIALISTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Authorized official

Name
Shana M Enochs
Title
Credentialing Specialist
Phone
(610) 327-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X OS006542L NU Primary

Addresses

Primary practice location

1591 Medical Drive
Pottstown, PA 19464

Mailing address

1610 Medical Drive
Suite 310
Pottstown, PA 19464
Phone (610) 327-4200

Other identifiers 2

IdentifierTypeStateIssuer
0859983000OtherPAKEYSTONE HMO
919367OtherPABLUE SHIELD ASSIGN ACCT

Other names 1

  • POTTSTOWN MEDICAL SPECIALISTS PULMONARY Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000589 PA Part B Supplier - Clinic/Group Practice 8224024096 Receives reassigned benefits from 51 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boyertown, PA; Collegeville, PA; Pottstown, PA; Royersford, PA; Stowe, PA

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Pottstown Med Specialis9 organizations share this tax ID, including this one
Part of
Pottstown Med Specialis

Other organizations with this tax ID 8

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

Locations

1610 Medical Dr
Ste 310
Pottstown, PA 19464
Phone (610) 327-4200

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": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1114042595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 MEDICAL DRIVE",
            "address_2": "SUITE 310",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "19464",
            "telephone_number": "610-327-4200",
            "fax_number": "484-945-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1591 MEDICAL DRIVE",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "19464",
            "telephone_number": "610-326-8005",
            "fax_number": "484-945-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMSI DIVISION OF PULMONARY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POTTSTOWN MEDICAL SPECIALISTS",
        "enumeration_date": "2007-03-21",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "ENOCHS",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "610-327-4200"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": "OS006542L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HMO",
            "identifier": "0859983000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ASSIGN ACCT",
            "identifier": "919367",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTTSTOWN MEDICAL SPECIALISTS PULMONARY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pottstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.