NPIMap

Organization Active NPI

Penncare Bucks County - Family Medicine

  • Non-Pharmacy Dispensing Site
  • Yardley, PA
National Provider Identifier
1164563573
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD029363E Issued in PA
Legal business name
PENNCARE BUCKS COUNTY - FAMILY MEDICINE
Practice address
62 S Main St
Yardley, PA 19067-1511
Phone
(215) 493-5535
NPI assigned
Feb 9, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kenny Heine
Title
Dir. of Operations
Phone
(858) 625-2990

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory
Tax ID family
Penncare-Pennsylvania Hospitalist Associates13 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 12

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

Locations

62 S Main St
Yardley, PA 19067
Phone (215) 493-5535

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD029363E PA Primary

Addresses

NPPES NPI Registry

Primary practice location

62 S Main St
Yardley, PA 19067-1511

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2012.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1164563573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990",
            "fax_number": "858-625-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 S MAIN ST",
            "city": "YARDLEY",
            "state": "PA",
            "postal_code": "190671511",
            "telephone_number": "215-493-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNCARE BUCKS COUNTY - FAMILY MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIR. OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD029363E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yardley, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.