Active NPI
Southeastern Pennsylvania Urologic Surgery, P.C.
- Urology Physician
- West Grove, PA
National Provider Identifier
1376723643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- SOUTHEASTERN PENNSYLVANIA UROLOGIC SURGERY, P.C.
- Practice address
- 1011 W Baltimore Pike
Ste 312
West Grove, PA 19390-9446 - Phone
- (510) 869-6851
- NPI assigned
- Nov 5, 2007
- 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
- Dr. Michael Chiusano, M.D.
- Title
- Owner
- Phone
- (610) 869-6851
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | Primary |
Addresses
Primary practice location
1011 W Baltimore Pike
Ste 312
West Grove, PA 19390-9446
Mailing address
1011 W Baltimore Pike
Ste 312
West Grove, PA 19390-9446
Phone (510) 869-6851
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2070420000 | Other | PA | KEYSTONE HPE |
| P484619 | Other | PA | OXFORD |
| 0015965780009 | Medicaid | PA | |
| 1378803 | Other | PA | PA BLUE SHIELD |
| 340019880 | Other | PA | RAIL ROAD MEDICARE |
| 1039444 | Other | PA | MERCY HEALTH PLAN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194220800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1291680000000",
"number": "1376723643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 W BALTIMORE PIKE",
"address_2": "STE 312",
"city": "WEST GROVE",
"state": "PA",
"postal_code": "193909446",
"telephone_number": "510-869-6851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 W BALTIMORE PIKE",
"address_2": "STE 312",
"city": "WEST GROVE",
"state": "PA",
"postal_code": "193909446",
"telephone_number": "510-869-6851"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEASTERN PENNSYLVANIA UROLOGIC SURGERY, P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-05",
"last_updated": "2010-12-07",
"status": "A",
"authorized_official_last_name": "CHIUSANO",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "610-869-6851",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HPE",
"identifier": "2070420000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P484619",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015965780009",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE SHIELD",
"identifier": "1378803",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "340019880",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY HEALTH PLAN",
"identifier": "1039444",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.