NPIMap

Organization Active NPI

Prospect Health Access Network, Inc.

  • Gynecologic Oncology Physician
  • Chester, PA
National Provider Identifier
1134574775
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
PROSPECT HEALTH ACCESS NETWORK, INC.
Practice address
1 Medical Center Blvd
Vivacqua Pav, Suite 441
Chester, PA 19013-3902
Phone
(610) 876-9640
Fax
(610) 876-1881
NPI assigned
May 2, 2016
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X NU Primary

Addresses

Primary practice location

1 Medical Center Blvd
Vivacqua Pav, Suite 441
Chester, PA 19013-3902

Mailing address

1 Medical Center Blvd
Vivacqua Pav, Suite 441
Chester, PA 19013-3902
Phone (610) 876-9640

Other names 1

  • Gynecologic Oncology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160613000737 PA Part B Supplier - Clinic/Group Practice 5698065142 Receives reassigned benefits from 730 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory
Tax ID family
Crozer Health Medical Group14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

1 Medical Center Blvd
Ste 441
Chester, PA 19013
Phone (610) 876-1029

3030 Garrett Rd
Drexel Hill, PA 19026
Phone (610) 622-7933

2010 W Chester Pike
Ste 350
Havertown, PA 19083
Phone (610) 924-0135

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1134574775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "address_2": "VIVACQUA PAV, SUITE 441",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133902",
            "telephone_number": "610-876-9640",
            "fax_number": "610-876-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "address_2": "VIVACQUA PAV, SUITE 441",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133902",
            "telephone_number": "610-876-9640",
            "fax_number": "610-876-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT HEALTH ACCESS NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-02",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gynecologic Oncology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Gynecologic Oncology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.