NPIMap

Organization Active NPI

Jersey Shore Hospital Foundation, Inc

Doing business as Jersey Shore Medical Associates

  • Family Medicine Physician
  • Avis, PA
National Provider Identifier
1417019498
Registry record updated Apr 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JERSEY SHORE HOSPITAL FOUNDATION, INC
Doing business as
Jersey Shore Medical Associates
Practice address
104 East Central Avenue
Avis, PA 17721
Phone
(570) 753-8620
Fax
(570) 753-5489
NPI assigned
Dec 15, 2006
Last updated
Apr 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2014

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

Authorized official

Name
Mr. Carey W. Plummer, CEO
Title
Ceo
Phone
(570) 398-3101

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

104 East Central Avenue
Avis, PA 17721

Mailing address

104 East Central Avenue
PO Box 430
Avis, PA 17721
Phone (570) 753-8620

Other names 1

  • Jersey Shore Medical Associates Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1417019498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 EAST CENTRAL AVENUE",
            "address_2": "PO BOX 430",
            "city": "AVIS",
            "state": "PA",
            "postal_code": "17721",
            "telephone_number": "570-753-8620",
            "fax_number": "570-753-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 EAST CENTRAL AVENUE",
            "city": "AVIS",
            "state": "PA",
            "postal_code": "17721",
            "telephone_number": "570-753-8620",
            "fax_number": "570-753-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY SHORE HOSPITAL FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "PLUMMER",
        "authorized_official_first_name": "CAREY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-398-3101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey Shore Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avis, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.