Individual provider Active NPI

Michael F Prime, DO

  • Family Medicine Physician
  • Newtown Square, PA
National Provider Identifier
1336209980
Registry record updated Jul 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS007913L Issued in PA
Practice address
3855 W Chester Pike Ste 300
Newtown Square, PA 19073
Phone
(484) 427-8000
Fax
(484) 427-8020
NPI assigned
Dec 12, 2006
Last updated
Jul 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS007913L PA Primary

Addresses

Primary practice location

3855 W Chester Pike Ste 300
Newtown Square, PA 19073

Mailing address

3855 W Chester Pike Ste 300
Newtown Square, PA 19073-2304
Phone (484) 427-8000

Other identifiers 1

IdentifierTypeStateIssuer
001399210MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100927000611 PA Practitioner - Family Practice 4688790785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

3855 W Chester Pike
Newton Square, PA 19073-2304

830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS007913LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Family Medicine CurrentSince May 1, 2016 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3855 West Chester Pike
Ste 300
Newtown Square, PA 19073
Phone (484) 337-2585

Organizations & group practices 1

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 5

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532649600000",
    "number": "1336209980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 W CHESTER PIKE STE 300",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732304",
            "telephone_number": "484-427-8000",
            "fax_number": "484-427-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 W CHESTER PIKE STE 300",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "19073",
            "telephone_number": "484-427-8000",
            "fax_number": "484-427-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIME",
        "first_name": "MICHAEL",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS007913L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001399210",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newtown Square, PA

Sources for this page

Verify at the official NPI Registry.