NPIMap

Organization Active NPI

Bloomsburg Physicians Services

Doing business as Jose Derr

  • Family Medicine Physician
  • Berwick, PA
National Provider Identifier
1477758407
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLOOMSBURG PHYSICIANS SERVICES
Doing business as
Jose Derr
Practice address
101 West 9TH Street
Berwick, PA 18603
Phone
(570) 387-2166
Fax
(570) 387-2316
NPI assigned
Jun 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Kristin A Hollister
Title
Assistant Practice Manager
Phone
(570) 387-2166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

101 West 9TH Street
Berwick, PA 18603

Mailing address

401 Glenn Ave
Bloomsburg, PA 17815-1419
Phone (570) 759-2600

Other identifiers 1

IdentifierTypeStateIssuer
50047313OtherPACBC

Other names 1

  • JOSE DERR Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bloomsburg Physicians Services14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477758407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 GLENN AVE",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151419",
            "telephone_number": "570-759-2600",
            "fax_number": "570-759-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WEST 9TH STREET",
            "city": "BERWICK",
            "state": "PA",
            "postal_code": "18603",
            "telephone_number": "570-387-2166",
            "fax_number": "570-387-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMSBURG PHYSICIANS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLISTER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ASSISTANT PRACTICE MANAGER",
        "authorized_official_telephone_number": "570-387-2166",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBC",
            "identifier": "50047313",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JOSE DERR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berwick, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.