NPIMap

Organization Active NPI

Keystone Medical Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Warminster, PA
National Provider Identifier
1235553496
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
KEYSTONE MEDICAL URGENT CARE, LLC
Practice address
1555 W. Street Road
Warminster, PA 18974-3100
Phone
(212) 257-2424
Fax
(929) 332-2565
NPI assigned
Feb 8, 2014
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Sampson Davis, MDNPI 1346242310
Title
Medical Director
Phone
(212) 257-2424

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X MD067050 PA
Urgent Care Clinic/Center 261QU0200X PA Primary

Addresses

Primary practice location

1555 W. Street Road
Warminster, PA 18974-3100

Mailing address

1555 W. Street Road
Warminster, PA 18974-3100
Phone (630) 952-1412

Other identifiers 2

IdentifierTypeStateIssuer
2281481MedicaidPA
1029092860001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160323001924 PA Part B Supplier - Clinic/Group Practice 2961623251 Receives reassigned benefits from 11 practitioners
Practice locations: East Stroudsburg, PA

National Provider Directory

National Provider Directory

Locations

1555 W Street Rd
Warminster, PA 18974
Phone (215) 293-9560

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1391817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1235553496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 W. STREET ROAD",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189743100",
            "telephone_number": "630-952-1412",
            "fax_number": "215-293-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 W. STREET ROAD",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189743100",
            "telephone_number": "212-257-2424",
            "fax_number": "929-332-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE MEDICAL URGENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-08",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SAMPSON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "212-257-2424",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "PA",
            "license": "MD067050",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2281481",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029092860001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warminster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.