NPIMap

Individual provider Active NPI

Premkumar Chandrakantbhai Patel, MD

  • Family Medicine Physician
  • Harrisburg, PA
National Provider Identifier
1144754177
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD471619 Issued in PA
Practice address
111 S Front St
Harrisburg, PA 17101-2010
Phone
(717) 231-8772
Fax
(717) 231-8435
NPI assigned
Apr 17, 2017
Last updated
Apr 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 29282 WV
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X MD471619 PA Primary

Addresses

Primary practice location

111 S Front St
Harrisburg, PA 17101-2010

Mailing address

111 S Front St
Harrisburg, PA 17101-2010

Other practice location 1

527 Medical Park Dr Ste 500
Bridgeport, WV 26330-9010
Phone (681) 342-3600

Other identifiers 1

IdentifierTypeStateIssuer
103800950MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ppatel178373@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200511000508 WV Practitioner - Family Practice 0941579486 Reassigns benefits to 1 organization
I20200807000021 PA Practitioner - Family PracticePractitioner - Hospitalist 0941579486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Health Hospitalist Services LLCGroup PAC ID 9739313545, 180 clinicians

Practice addresses (Care Compare)

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 231-8772

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.15 of 100Reported as group
Quality
88.49
Promoting interoperability
100
Improvement activities
40
Cost
72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD471619PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Hospitalist Services LLC Family Medicine CurrentSince Aug 3, 2020 Accepting new patients
Signify Health Medical Associates, PLLC General Practice CurrentSince Mar 1, 2020 Accepting new patients
Upmc Pinnacle Hospitals Past Accepting new patients
Upmc Pinnacle Hospitals Past Accepting new patients

Locations

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

409 S 2nd St
Ste 2F
Harrisburg, PA 17104
Phone (717) 231-8049

4300 Londonderry Rd
Lower Paxton, PA 17109
Phone (717) 597-7044

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: ppatel299148@upmc.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1144754177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S FRONT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171012010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S FRONT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171012010",
            "telephone_number": "717-231-8772",
            "fax_number": "717-231-8435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "527 Medical Park Dr Ste 500",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "WV",
            "postal_code": "263309010",
            "country_code": "US",
            "telephone_number": "681-342-3600",
            "fax_number": "681-342-3625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "PREMKUMAR",
        "middle_name": "CHANDRAKANTBHAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WV",
            "license": "29282",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD471619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103800950",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppatel178373@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "111 S Front St",
            "city": "Harrisburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "171012010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

Verify at the official NPI Registry.