NPIMap

Individual provider Active NPI

Thomas T Roesch, PA

  • Surgical Physician Assistant
  • Bryn Mawr, PA
National Provider Identifier
1245206929
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA002926L Issued in PA
Practice address
830 Old Lancaster Rd Ste 210
Bryn Mawr, PA 19010
Phone
(610) 527-1600
Fax
(610) 527-0824
NPI assigned
Feb 23, 2006
Last updated
Jun 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA002926L PA Primary

Addresses

Primary practice location

830 Old Lancaster Rd Ste 210
Bryn Mawr, PA 19010

Mailing address

830 Old Lancaster Rd Ste 210
Bryn Mawr, PA 19010-3118
Phone (610) 527-1600

Other practice location 1

100 E Lancaster Ave
JD Lankenau Pavilion, Mezzanine
Wynnewood, PA 19096-3450
Phone (484) 476-1000

Other identifiers 1

IdentifierTypeStateIssuer
232359401OtherPAMAIN LINE HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051025000623 PA Practitioner - Physician Assistant 6103843586 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

1068 W Baltimore Pike
Media, PA 19063-5104
Phone (610) 566-9400

255 W Lancaster Ave
Paoli, PA 19301-1763

830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA002926LPAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Aug 23, 2015 Accepting new patients
Tower Health Medical Group CurrentSince Jun 17, 2013 Accepting new patients
Tower Health Medical Group CurrentSince Jun 17, 2013 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 23, 2015 Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients

Locations

800 Walnut St
Fl 20
William Penn Annex West, PA 19107
Phone (215) 829-2092

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1245206929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 OLD LANCASTER RD STE 210",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103118",
            "telephone_number": "610-527-1600",
            "fax_number": "610-527-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 OLD LANCASTER RD STE 210",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "19010",
            "telephone_number": "610-527-1600",
            "fax_number": "610-527-0824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Lancaster Ave",
            "address_2": "JD Lankenau Pavilion, Mezzanine",
            "address_purpose": "LOCATION",
            "city": "Wynnewood",
            "state": "PA",
            "postal_code": "190963450",
            "country_code": "US",
            "telephone_number": "484-476-1000",
            "fax_number": "484-476-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROESCH",
        "first_name": "THOMAS",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA002926L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAIN LINE HEALTHCARE",
            "identifier": "232359401",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

Verify at the official NPI Registry.