Individual provider Active NPI

Autumn Breanna Perdue, PA-C

  • Medical Physician Assistant
  • Allentown, PA
National Provider Identifier
1548922347
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA062950 Issued in PA
Practice address
1200 S Cedar Crest Blvd
Allentown, PA 18103-6202
Phone
(610) 402-5369
Fax
(610) 402-5959
NPI assigned
Oct 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA062950 PA Primary

Addresses

Primary practice location

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

Mailing address

1424 Kelchner Rd
Bethlehem, PA 18018-1517
Phone (540) 420-3978

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL n/a Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20211021001257 PA Practitioner - Physician Assistant 1153719323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

1200 S Cedar Crest Blvd 3Rd FL Kasych
LVPG Burn Surgery
Allentown, PA 18103-6202
Phone (610) 402-8355

1200 S Cedar Crest Blvd FL
1 LVPG Nephrology
Allentown, PA 18103-6202
Phone (610) 402-8510

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

2100 Mack Blvd
FL 4
Allentown, PA 18103-5622

2545 Schoenersville Rd
Bethlehem, PA 18017-7300

700 E Broad St
LVPG Emergency Medicine
Hazleton, PA 18201-6835
Phone (570) 501-4193

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA062950PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Oct 18, 2021 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 18, 2021 Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

1200 S Cedar Crest Blvd
Allentown, PA 18103
Phone (484) 862-3200

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1548922347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 KELCHNER RD",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180181517",
            "telephone_number": "540-420-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202",
            "telephone_number": "610-402-5369",
            "fax_number": "610-402-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERDUE",
        "first_name": "AUTUMN",
        "middle_name": "BREANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA062950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "n/a",
            "affiliation": "N",
            "endpointDescription": "n/a",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1200 S Cedar Crest Blvd",
            "city": "Allentown",
            "state": "PA",
            "country_code": "US",
            "postal_code": "181036202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.