NPIMap

Organization Active NPI

Erickson Health Medical Group of Pennsylvania PC

  • Internal Medicine Physician
  • Glen Mills, PA
National Provider Identifier
1235149477
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ERICKSON HEALTH MEDICAL GROUP OF PENNSYLVANIA PC
Practice address
100 Maris Grove Way
Glen Mills, PA 19342
Phone
(610) 387-4520
Fax
(610) 387-4526
NPI assigned
Aug 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Authorized official

Name
Matthew J Narrett, MD
Title
Senior VP and Chief Medical Officer
Phone
(410) 402-2257

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Gerontology Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SG0600X
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0808X

Addresses

Primary practice location

100 Maris Grove Way
Glen Mills, PA 19342

Mailing address

5730 Executive Dr Ste 230
Catonsville, MD 21228-1762
Phone (610) 387-4520

Other identifiers 6

IdentifierTypeStateIssuer
22-55915002OtherKEYSTONE
2055830OtherHIGHMARK BLUE SHIELD
758848OtherBCBS OF PA
2045582OtherHIGHMARK BS
01-24638OtherEVERCARE
2055836OtherHIGHMARK BLUE SHIELD PODIATRISTS

Other names 1

  • Maris Grove Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050209000099 PA Part B Supplier - Clinic/Group Practice 3870544083 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glen Mills, PA; Warminster, PA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ann'S Choice Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

500 Maris Grove Way
Glen Mills, PA 19342
Phone (610) 387-4470

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1235149477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 EXECUTIVE DR STE 230",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212281762",
            "telephone_number": "610-387-4520",
            "fax_number": "610-387-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIS GROVE WAY",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "19342",
            "telephone_number": "610-387-4520",
            "fax_number": "610-387-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON HEALTH MEDICAL GROUP OF PENNSYLVANIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "NARRETT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VP AND CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "410-402-2257",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "22-55915002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "2055830",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF PA",
            "identifier": "758848",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "2045582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "01-24638",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD PODIATRISTS",
            "identifier": "2055836",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maris Grove Medical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Maris Grove Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glen Mills, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.