NPIMap

Organization Active NPI

Riddle Village

Doing business as Monticello House at Riddle Village

  • Internal Medicine Physician
  • Media, PA
National Provider Identifier
1588446629
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RIDDLE VILLAGE
Doing business as
Monticello House at Riddle Village
Practice address
1048 W Baltimore Pike
Media, PA 19063-5168
Phone
(484) 621-1100
Fax
(610) 627-4789
NPI assigned
Oct 13, 2023
Last updated
Oct 13, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
RIDDLE VILLAGEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Authorized official

Name
Cathy Frewin
Title
Ar Specialist
Phone
(610) 891-3806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1048 W Baltimore Pike
Media, PA 19063-5168

Mailing address

1048 W Baltimore Pike
Media, PA 19063-5168
Phone (484) 621-1100

Other names 1

  • Monticello House at Riddle Village Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240126003871 PA Part B Supplier - Clinic/Group Practice 7416106935 Receives reassigned benefits from 1 practitioner
Practice locations: Media, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Riddle Village2 organizations share this tax ID, including this one
Part of
Riddle Village

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1588446629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 W BALTIMORE PIKE",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635168",
            "telephone_number": "484-621-1100",
            "fax_number": "610-627-4789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 W BALTIMORE PIKE",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635168",
            "telephone_number": "484-621-1100",
            "fax_number": "610-627-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDDLE VILLAGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIDDLE VILLAGE",
        "enumeration_date": "2023-10-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "FREWIN",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "AR SPECIALIST",
        "authorized_official_telephone_number": "610-891-3806"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monticello House at Riddle Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Media, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; 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.