Organization Active NPI

Family Health Psychology Center LLC

  • Psychologist
  • Philadelphia, PA
National Provider Identifier
1457583833
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
FAMILY HEALTH PSYCHOLOGY CENTER LLC
Practice address
506 W Mount Airy Ave
Philadelphia, PA 19119-2948
Phone
(610) 237-5444
NPI assigned
Aug 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

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

Authorized official

Name
Brett Boyer, PHD
Title
MBR
Phone
(610) 237-5444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

506 W Mount Airy Ave
Philadelphia, PA 19119-2948

Mailing address

506 W Mount Airy Ave
Philadelphia, PA 19119-2948
Phone (610) 237-5444

Other identifiers 5

IdentifierTypeStateIssuer
1024063200001MedicaidPA
3775109000OtherPAINDEPENDENCE BLUE CROSS
9657530OtherAETNA
600633164OtherMAGELLAN
2138698OtherPABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100115000030 PA Part B Supplier - Clinic/Group Practice 8022150945 Receives reassigned benefits from 4 practitioners
Practice locations: Secane, PA

National Provider Directory

National Provider Directory
Tax ID family
Center for Health and Coping3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

39 S Chester Pike
Lowr
Glenolden, PA 19036
Phone (484) 540-8265

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1457583833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 W MOUNT AIRY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192948",
            "telephone_number": "610-237-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 W MOUNT AIRY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192948",
            "telephone_number": "610-237-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH PSYCHOLOGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "610-237-5444",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024063200001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "3775109000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9657530",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "600633164",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2138698",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.