NPIMap

Organization Active NPI

Img Nursing Home Care, P.C.

  • Family Medicine Physician
  • Pottsville, PA
National Provider Identifier
1144843897
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IMG NURSING HOME CARE, P.C.
Practice address
82 Tunnel Rd
Pottsville, PA 17901-3869
Phone
(570) 622-5455
Fax
(570) 622-5493
NPI assigned
May 28, 2020
Last updated
May 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Authorized official

Name
Kimberly Walsh
Title
Director of Operations
Phone
(570) 622-5455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

82 Tunnel Rd
Pottsville, PA 17901-3869

Mailing address

82 Tunnel Rd
Pottsville, PA 17901-3869
Phone (570) 622-5455

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200708002046 PA Part B Supplier - Clinic/Group Practice 8628491735 Receives reassigned benefits from 19 practitioners
Practice locations: Pottsville, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1144843897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 TUNNEL RD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013869",
            "telephone_number": "570-622-5455",
            "fax_number": "570-622-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 TUNNEL RD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013869",
            "telephone_number": "570-622-5455",
            "fax_number": "570-622-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMG NURSING HOME CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "570-622-5455"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.