NPIMap

Organization Active NPI

Phoenixville Medical Group

  • Internal Medicine Physician
  • Phoenixville, PA
National Provider Identifier
1144540337
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD024972E Issued in PA
Legal business name
PHOENIXVILLE MEDICAL GROUP
Practice address
500 Gay Street
Phoenixville, PA 19460
Phone
(610) 935-7500
Fax
(610) 935-4338
NPI assigned
Jun 10, 2010
Organization subpart
Yes
Parent organization
POTTSTOWN MEDICAL SPECIALISTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

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

Authorized official

Name
Katie Harrison
Title
Communications Administrator
Phone
(610) 327-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MD024972E PA Primary

Addresses

Primary practice location

500 Gay Street
Phoenixville, PA 19460

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0007964850006MedicaidPA
026191OtherPABLUE SHIELD

Other names 1

  • POTTSTOWN MEDICAL SPECIALISTS PHOENIXVILLE 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
Part of
Stowe Medical Group

Practitioners & affiliated clinicians

Practitioners 1

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": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1144540337",
    "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": "610-327-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GAY STREET",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "19460",
            "telephone_number": "610-935-7500",
            "fax_number": "610-935-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIXVILLE MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POTTSTOWN MEDICAL SPECIALISTS",
        "enumeration_date": "2010-06-10",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "COMMUNICATIONS ADMINISTRATOR",
        "authorized_official_telephone_number": "610-327-4200"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD024972E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007964850006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "026191",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTTSTOWN MEDICAL SPECIALISTS PHOENIXVILLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Mar 28, 2014; 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.