NPIMap

Organization Active NPI

Mercy Management of Southeastern Pennsylvania

Doing business as MMS-Mercy Medical Associates at Eastwick

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1194701292
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Doing business as
MMS-Mercy Medical Associates at Eastwick
Practice address
2821 Island Ave
Suite D& E
Philadelphia, PA 19153-2300
Phone
(215) 863-6110
Fax
(215) 863-6111
NPI assigned
Dec 20, 2005
Last updated
May 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Mr. Doug;As C Smith
Title
VP Financial Services
Phone
(610) 567-6964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2821 Island Ave
Suite D& E
Philadelphia, PA 19153-2300

Mailing address

1 W Elm St
2ND Floor
Conshohocken, PA 19428-2007
Phone (610) 567-6964

Other identifiers 15

IdentifierTypeStateIssuer
2234269001OtherPAAMERIHEALTH DELAWARE
2234269001OtherPAKEYSTONE HEALTH PCP 65
100778793 0152MedicaidPA
125186900OtherPADEPT OF LABOR
2059546OtherPAAETNA MEDICARE
1551070OtherPAAMERIHEALTH ADMIN
1551070OtherPABLUE SHIELD COMP
2234269001OtherPAAMERIHEALTH NEW JERSEY
2234269001OtherPAAMERIHEALTH HMO
2234269001OtherPABLUE SHIELD ILIN
30010759OtherPAKEYSTONE MERCY
1551070OtherPABLUE SHIELD
2234269001OtherPAKEYSTONE HEALTH PLAN PCP
1551070OtherPABLUE SHIELD PA 65
2059546OtherPAAETNA HMO PPO

Other names 1

  • MMS-Mercy Medical Associates at Eastwick Doing business as

National Provider Directory

National Provider Directory

Locations

2821 Island Ave
Ste D
Philadelphia, PA 19153
Phone (215) 863-6110

Practitioners & affiliated clinicians

Practitioners 11

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": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1194701292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W ELM ST",
            "address_2": "2ND FLOOR",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282007",
            "telephone_number": "610-567-6964",
            "fax_number": "610-567-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 ISLAND AVE",
            "address_2": "SUITE D& E",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191532300",
            "telephone_number": "215-863-6110",
            "fax_number": "215-863-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUG;AS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP FINANCIAL SERVICES",
        "authorized_official_telephone_number": "610-567-6964",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH DELAWARE",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PCP 65",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100778793 0152",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "125186900",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA MEDICARE",
            "identifier": "2059546",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH ADMIN",
            "identifier": "1551070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD COMP",
            "identifier": "1551070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH NEW JERSEY",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ILIN",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "30010759",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1551070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PLAN PCP",
            "identifier": "2234269001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PA 65",
            "identifier": "1551070",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO PPO",
            "identifier": "2059546",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMS-Mercy Medical Associates at Eastwick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 9, 2008; 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.