Individual provider Active NPI

Mark A. Monaco, D.O.

  • Family Medicine Physician
  • Broomall, PA
National Provider Identifier
1164434874
Registry record updated May 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS-007200-L Issued in PA
Practice address
2000 Sproul Rd Suite 100
Marple Commons
Broomall, PA 19008-2424
Phone
(610) 353-3500
Fax
(610) 353-2015
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS-007200-L PA Primary

Addresses

Primary practice location

2000 Sproul Rd Suite 100
Marple Commons
Broomall, PA 19008-2424

Mailing address

2000 Sproul Rd Suite 100
Marple Commons
Broomall, PA 19008-2424
Phone (610) 353-3500

Other identifiers 10

IdentifierTypeStateIssuer
079135OtherPAPA BLUE SHIELD
112678OtherPACOVENTRY
OS-007200-LOtherPASTATE LICENSE NUMBER
0222047000OtherPAKEYSTONE
30025953OtherPAKEYSTONE MERCY
0014669940006MedicaidPA
010056677OtherPAMEDICARE RR
0222047000OtherPAIBC PRODUCTS
118066OtherPAAETNA
P663879OtherPAOXFORD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100713000103 PA Practitioner - Family Practice 9335208651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

1991 Sproul Rd
Broomall, PA 19008-3512
Phone (610) 325-1390

Hospital & facility affiliations

  • Main Line Health Home Care & Hospice - Home Health Home health agency, Radnor, PA, CCN 397012
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS-007200-LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Family Medicine CurrentSince Feb 1, 2020 Accepting new patients

Locations

1991 Sproul Rd
Broomall, PA 19008
Phone (484) 476-3700

1991 Sproul Rd
Ste 140
Broomall, PA 19008
Phone (610) 325-0309

2000 Sproul Rd
Ste 100
Broomall, PA 19008
Phone (484) 337-5314

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243382400000",
    "number": "1164434874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 SPROUL RD SUITE 100",
            "address_2": "MARPLE COMMONS",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190082424",
            "telephone_number": "610-353-3500",
            "fax_number": "610-353-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 SPROUL RD SUITE 100",
            "address_2": "MARPLE COMMONS",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190082424",
            "telephone_number": "610-353-3500",
            "fax_number": "610-353-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONACO",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2009-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS-007200-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD",
            "identifier": "079135",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "112678",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "OS-007200-L",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "0222047000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "30025953",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014669940006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "010056677",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC PRODUCTS",
            "identifier": "0222047000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "118066",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P663879",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomall, PA

Sources for this page

Verify at the official NPI Registry.