NPIMap

Organization Active NPI

Merakey Parkside Recovery

  • Community/Behavioral Health Agency
  • Philadelphia, PA
National Provider Identifier
1194468413
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MERAKEY PARKSIDE RECOVERY
Practice address
1745 N 4TH St
Philadelphia, PA 19122-3008
Phone
(215) 836-3131
Fax
(215) 273-5975
NPI assigned
Apr 14, 2022
Last updated
Jan 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Mr. Norman E Tilson Jr.
Title
Corp Director of Business Operation
Phone
(215) 836-3131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1745 N 4TH St
Philadelphia, PA 19122-3008

Mailing address

620 Germantown Pike
Lafayette Hill, PA 19444-1810
Phone (215) 836-3131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Opioid treatment program
Medicare-enrolled since Aug 7, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201203000181 PA Part B Supplier - Opioid Treatment Program (Otp) 2163683327 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

Other NPIs on the same Medicare enrollment 2

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

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
39D2285786Merakey Parkside Recovery1745 N 4TH Street, Philadelphia, PA 19122Certificate of waiverJul 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Merakey Parkside Recovery9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1745 N 4th St
Philadelphia, PA 19122
Phone (215) 236-0100

4806 Frankford Ave
Philadelphia, PA 19124
Phone (215) 533-6204

5429 Germantown Ave
Philadelphia, PA 19144
Phone (215) 754-0240

5429 Germantown Ave
Fl 2
Philadelphia, PA 19144
Phone (215) 754-0240

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1194468413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 GERMANTOWN PIKE",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441810",
            "telephone_number": "215-836-3131",
            "fax_number": "215-273-5975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 N 4TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191223008",
            "telephone_number": "215-836-3131",
            "fax_number": "215-273-5975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERAKEY PARKSIDE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-14",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "TILSON",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CORP DIRECTOR OF BUSINESS OPERATION",
        "authorized_official_telephone_number": "215-836-3131",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.