Active NPI
Trinity Health Mid-Atlantic Medical Group
- Family Medicine Physician
- Secane, PA
National Provider Identifier
1285158105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
- Practice address
- 925 Providence Rd Ste 8/9
Secane, PA 19018-2920 - Phone
- (610) 394-1234
- Fax
- (610) 284-4811
- NPI assigned
- Aug 2, 2017
- Last updated
- Mar 13, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Julie Keese
- Title
- VP, Finance and Cfo
- Phone
- (301) 754-7201
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
925 Providence Rd Ste 8/9
Secane, PA 19018-2920
Mailing address
41 University Dr Ste 300
Newtown, PA 18940-1873
Phone (734) 343-2654
Other names 2
- Mercy Medical Associates at Providence
- THMA MG Primary Care Providence
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040326000613 | PA | Part B Supplier - Clinic/Group Practice | 7416861885 |
Receives reassigned benefits from 703 practitioners This NPI is an additional NPI on the enrollment |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D0939193 | Mercy Medical Assoc at Providence | Certificate of waiver | Jan 21, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 9
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.
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- Hospitalist Physician
- Langhorne, PA
- NPI 1265010557
-
- Emergency Medicine Physician
- Philadelphia, PA
- NPI 1538570882
-
- Surgical Physician Assistant
- Camp Hill, PA
- NPI 1861661886
-
- Emergency Medicine Physician
- Philadelphia, PA
- NPI 1518371178
-
- Internal Medicine Physician
- Secane, PA
- NPI 1972660975
-
- Surgery Physician
- Niagara Falls, NY
- NPI 1518148774
-
- Physician Assistant
- Pennington, NJ
- NPI 1699433359
-
- Internal Medicine Physician
- Secane, PA
- NPI 1396052460
-
- Family Medicine Physician
- Newark, DE
- NPI 1730705260
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1773360000000",
"number": "1285158105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 UNIVERSITY DR STE 300",
"city": "NEWTOWN",
"state": "PA",
"postal_code": "189401873",
"telephone_number": "734-343-2654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 PROVIDENCE RD STE 8/9",
"city": "SECANE",
"state": "PA",
"postal_code": "190182920",
"telephone_number": "610-394-1234",
"fax_number": "610-284-4811"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2017-08-02",
"last_updated": "2026-03-13",
"certification_date": "2026-03-13",
"status": "A",
"authorized_official_last_name": "KEESE",
"authorized_official_first_name": "JULIE",
"authorized_official_title_or_position": "VP, FINANCE AND CFO",
"authorized_official_telephone_number": "301-754-7201"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1068.1",
"affiliationName": "Cobius Healthcare Solutions",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2720 Dundee Rd # 302",
"city": "Northbrook",
"state": "IL",
"country_code": "US",
"postal_code": "600622609",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Mercy Medical Associates at Providence",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "THMA MG Primary Care Providence",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Secane, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.