NPIMap

Organization Active NPI

Phoenixville Specialty Clinics, LLC

  • Urology Physician
  • Phoenixville, PA
National Provider Identifier
1235229923
Registry record updated May 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PHOENIXVILLE SPECIALTY CLINICS, LLC
Practice address
824 Main St Ste 306
Phoenixville, PA 19460-4478
Phone
(610) 933-1133
Fax
(610) 933-4238
NPI assigned
Oct 13, 2006
Last updated
May 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2019

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

Authorized official

Name
Luis Rosa
Title
VP Payor Contracting
Phone
(484) 628-2099

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

824 Main St Ste 306
Phoenixville, PA 19460-4478

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7000

Other practice location 1

420 W Linfield Trappe Rd Ste 2001
Limerick, PA 19468-4278
Phone (610) 459-8444

Other identifiers 1

IdentifierTypeStateIssuer
1017628220001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061117000409 PA Part B Supplier - Clinic/Group Practice 9335147784 Receives reassigned benefits from 49 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wyncote, PA; Phildelphia, PA; Philadelphia, PA; Flourtown, PA

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

420 W Linfield Trappe Rd
Ste 2001
Limerick, PA 19468
Phone (610) 459-8444

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557360000000",
    "number": "1235229923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 MAIN ST STE 306",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194604478",
            "telephone_number": "610-933-1133",
            "fax_number": "610-933-4238"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 W Linfield Trappe Rd Ste 2001",
            "address_purpose": "LOCATION",
            "city": "Limerick",
            "state": "PA",
            "postal_code": "194684278",
            "country_code": "US",
            "telephone_number": "610-459-8444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHOENIXVILLE SPECIALTY CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2019-05-09",
        "status": "A",
        "authorized_official_last_name": "ROSA",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "VP PAYOR CONTRACTING",
        "authorized_official_telephone_number": "484-628-2099"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017628220001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenixville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; 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.