Individual provider Active NPI

Colin Anthony Pumphrey

  • Physician Assistant
  • Berlin, NJ
National Provider Identifier
1447987003
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00749200 Issued in NJ
Practice address
175 Cross Keys Rd
Berlin, NJ 08009-9263
Phone
(856) 767-0077
NPI assigned
Aug 3, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00749200 NJ Primary

Addresses

Primary practice location

175 Cross Keys Rd
Berlin, NJ 08009-9263

Mailing address

401 Route 73 N Ste 320
Marlton, NJ 08053-3426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221229000904 NJ Practitioner - Physician Assistant 6507236999 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00749200NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advocare, LLC CurrentSince Oct 3, 2022 Accepting new patients
Advocare , LLC CurrentSince Oct 3, 2022 Accepting new patients
Advocare, LLC Past Accepting new patients

Locations

339 N Route 73
Ste 1
Berlin, NJ 08009
Phone (856) 767-8228

132 Grove St
Ste A
Haddonfield, NJ 08033
Phone (856) 354-2211

401 Route 73 N
Ste 320
Marlton, NJ 08053
Phone (609) 471-1033

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1447987003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ROUTE 73 N STE 320",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CROSS KEYS RD",
            "city": "BERLIN",
            "state": "NJ",
            "postal_code": "080099263",
            "telephone_number": "856-767-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUMPHREY",
        "first_name": "COLIN",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-03",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00749200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, NJ

Sources for this page

Verify at the official NPI Registry.