NPIMap

Individual provider Active NPI

Russell F. Mazda, D.O.

  • Emergency Medicine Physician
  • Phoenixville, PA
National Provider Identifier
1124082813
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS004596L Issued in PA
Practice address
140 Nutt Rd
Phoenixville, PA 19460-3906
Phone
(610) 983-1221
NPI assigned
Apr 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS004596L PA Primary

Addresses

Primary practice location

140 Nutt Rd
Phoenixville, PA 19460-3906

Mailing address

PO Box 425
Lederach, PA 19450-0425
Phone (800) 528-0006

Other identifiers 7

IdentifierTypeStateIssuer
0010174790010MedicaidPA
457175OtherPAHIGHMARK BLUE SHIELD
OS004596LOtherPAHEALTH PARTNERS
30021002OtherPAKEYSTONE MERCY HP
8821743OtherPACIGNA HMO/PPO
0033070000OtherPAPERSONAL CHOICE/KHPE
0033070000OtherPAAMERIHEALTH/INTERCOUNTY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey/Pennsylvania Em-I Medical Services PC Emergency Medicine Past Accepting new patients
Emergency Physician Specialists Inc Emergency Medicine Past Accepting new patients
Main Line Emergency Med Associates LLC Emergency Medicine Past Accepting new patients
Burholme Emergency Care Specialists LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1124082813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 425",
            "city": "LEDERACH",
            "state": "PA",
            "postal_code": "194500425",
            "telephone_number": "800-528-0006",
            "fax_number": "732-349-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NUTT RD",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194603906",
            "telephone_number": "610-983-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZDA",
        "first_name": "RUSSELL",
        "middle_name": "F.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2011-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS004596L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010174790010",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "457175",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "OS004596L",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HP",
            "identifier": "30021002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HMO/PPO",
            "identifier": "8821743",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE/KHPE",
            "identifier": "0033070000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH/INTERCOUNTY",
            "identifier": "0033070000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenixville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; 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.