NPIMap

Organization Active NPI

Fornance Physician Services, Inc

Doing business as Broad Axe Family Medicine

  • Family Medicine Physician
  • Blue Bell, PA
National Provider Identifier
1184678666
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FORNANCE PHYSICIAN SERVICES, INC
Doing business as
Broad Axe Family Medicine
Practice address
721 Skippack Pike
Suite 3
Blue Bell, PA 19422-1700
Phone
(215) 793-0600
Fax
(610) 793-0759
NPI assigned
May 20, 2006
Last updated
Nov 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

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

Authorized official

Name
Vera Burnett-Robins
Title
Director Physician Billing
Phone
(484) 622-7391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

721 Skippack Pike
Suite 3
Blue Bell, PA 19422-1700

Mailing address

PO Box 789967
Philadelphia, PA 19178-9967
Phone (484) 622-7395

Other identifiers 10

IdentifierTypeStateIssuer
7990725OtherPACIGNA HMO/PPO
0274457001OtherPAAMERIHEALTH/INTERCOUNTY
1065049OtherPAKEYSTONE MERCY
2120908OtherPAALLIANCE (MAMSI)
5389597OtherPAAETNA PPO
085595OtherPAAETNA HMO
259541OtherPAHIGHMARK BLUE SHIELD
CI5397OtherPARRM
0274457001OtherPAIBC - PC/KHPE
33022OtherPAHEALTH PARTNERS SITE #

Other names 1

  • Broad Axe Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040216000037 PA Part B Supplier - Clinic/Group Practice 8527962661 Receives reassigned benefits from 215 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King of Prussia, PA; Lansdale, PA; Norristown, PA; North Wales, PA; Plymouth Meeting, PA; East Norriton, PA; Audubon, PA; Blue Bell, PA…

Other NPIs on the same Medicare enrollment 36

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 36

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0939225Broad Axe Family Medicine721 Skippack Pike Suite 3, Blue Bell, PA 19422Certificate of waiverJan 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fornance Physician Services Inc28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

1330 Powell St
Ste 507
Norristown, PA 19401
Phone (484) 622-7300

212 N Main St
Ste 203
North Wales, PA 19454
Phone (215) 699-1501

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1184678666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 789967",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191789967",
            "telephone_number": "484-622-7395",
            "fax_number": "484-622-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 SKIPPACK PIKE",
            "address_2": "SUITE 3",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "194221700",
            "telephone_number": "215-793-0600",
            "fax_number": "610-793-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORNANCE PHYSICIAN SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "BURNETT-ROBINS",
        "authorized_official_first_name": "VERA",
        "authorized_official_title_or_position": "DIRECTOR PHYSICIAN BILLING",
        "authorized_official_telephone_number": "484-622-7391"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HMO/PPO",
            "identifier": "7990725",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH/INTERCOUNTY",
            "identifier": "0274457001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "1065049",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE (MAMSI)",
            "identifier": "2120908",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5389597",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "085595",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "259541",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRM",
            "identifier": "CI5397",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC - PC/KHPE",
            "identifier": "0274457001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS SITE #",
            "identifier": "33022",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broad Axe Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broad Axe Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Bell, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.