Active NPI
David Michael Raezer, MD
- Urology Physician
- Broomall, PA
National Provider Identifier
1588761639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD030565L
- Practice address
- 1999 Sproul Rd
Suites 12 and 16
Broomall, PA 19008-3522 - Phone
- (610) 534-6100
- Fax
- (610) 534-6104
- NPI assigned
- Sep 20, 2006
- Last updated
- May 7, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD030565L | PA | Primary |
Addresses
Primary practice location
1999 Sproul Rd
Suites 12 and 16
Broomall, PA 19008-3522
Mailing address
1999 Sproul Rd
Suites 12 and 16
Broomall, PA 19008-3522
Phone (610) 534-6100
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0031117000 | Other | PA | PERSONAL CHOICE ID |
| 0031117000 | Other | PA | AMERIHEALTH ID |
| 146871 | Other | PA | BLUE SHIELD PROVIDER # |
| P0034748 | Other | PA | TRICARE PROVIDER ID # |
| P00252734 | Other | PA | RAILROAD MEDICARE ID |
| 025027 | Other | PA | BLAIR MILL ADMINISTRATORS |
| 12459 | Other | PA | ELDER HEALTH ID# |
| 36158333 | Other | PA | MULTIPLAN ID# |
| CL6874 | Other | PA | RAILROAD MEDICARE GROUP # |
| 0007379020002 | Medicaid | PA | |
| 0007380240001 | Medicaid | PA | |
| 0031117000 | Other | PA | KEYSTONE HEALTH PLAN EAST |
| 0073802406 | Other | PA | AMERICHOICE ID # |
| 1202110002 | Other | PA | CIGNA |
| 4088087 | Other | PA | AETNA PROVIDER # |
| DES178 | Other | PA | OXFORD HEALTH PLAN ID # |
| 2327902 | Other | NJ | NJ MEDICAID PROVIDER # |
Other names 1
- Usurg Associates Inc
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Urology Physician
- Broomall, PA
- NPI 1013000983
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588809600000",
"number": "1588761639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1999 SPROUL RD",
"address_2": "SUITES 12 AND 16",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083522",
"telephone_number": "610-534-6100",
"fax_number": "610-534-6104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1999 SPROUL RD",
"address_2": "SUITES 12 AND 16",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083522",
"telephone_number": "610-534-6100",
"fax_number": "610-534-6104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAEZER",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2020-05-07",
"certification_date": "2020-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "PA",
"license": "MD030565L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CHOICE ID",
"identifier": "0031117000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH ID",
"identifier": "0031117000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER #",
"identifier": "146871",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE PROVIDER ID #",
"identifier": "P0034748",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE ID",
"identifier": "P00252734",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLAIR MILL ADMINISTRATORS",
"identifier": "025027",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDER HEALTH ID#",
"identifier": "12459",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN ID#",
"identifier": "36158333",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP #",
"identifier": "CL6874",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0007379020002",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0007380240001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH PLAN EAST",
"identifier": "0031117000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE ID #",
"identifier": "0073802406",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1202110002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER #",
"identifier": "4088087",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD HEALTH PLAN ID #",
"identifier": "DES178",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ MEDICAID PROVIDER #",
"identifier": "2327902",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "USURG",
"last_name": "INC",
"middle_name": "ASSOCIATES",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Broomall, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.