NPIMap

Organization Active NPI

Alliance Cancer Specialists

Doing business as Main Line Oncology Hematology Associates

  • Hematology & Oncology Physician
  • Wynnewood, PA
National Provider Identifier
1598877813
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MC542764A Issued in PA
Legal business name
ALLIANCE CANCER SPECIALISTS
Doing business as
Main Line Oncology Hematology Associates
Practice address
100 Lancaster Ave
Wynnewood, PA 19096
Phone
(610) 645-2494
Fax
(610) 645-4456
NPI assigned
Aug 31, 2006
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Kim Distasio
Title
Practice Manager
Phone
(610) 645-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MC542764A PA Primary

Addresses

Primary practice location

100 Lancaster Ave
Wynnewood, PA 19096

Mailing address

100 E Lancaster Avenue Suite 100
Wynnewood, PA 19096
Phone (610) 645-2494

Other identifiers 3

IdentifierTypeStateIssuer
000279824OtherBLUE SHIELD
919262MedicaidPA
0094364000OtherBLUE CROSS

Other names 1

  • Main Line Oncology Hematology Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230728000137 PA DME Supplier - Physician - General Practice 7214194091 Practice locations: Wynnewood, 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
Alliance Cancer Specialists PC4 organizations share this tax ID, including this one
Part of
Consultants in Med Onc Hemo

Other organizations with this tax ID 3

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

Locations

599 W State St
Ste 312
Doylestown, PA 18901
Phone (215) 345-8444

1020 Baltimore Pike
Ste 340
Glen Mills, PA 19342
Phone (484) 836-2448

5000 Frankford Ave
Ste 2B
Philadelphia, PA 19124
Phone (215) 612-5250

33 W Chester Pike
Ridley Park, PA 19078
Phone (610) 521-2010

100 E Lancaster Ave
Ste 100
Wynnewood, PA 19096
Phone (610) 645-2494

100 E Lancaster Ave
Ste B20
Wynnewood, PA 19096
Phone (610) 645-2494

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 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1598877813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVENUE SUITE 100",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "610-645-2494",
            "fax_number": "610-645-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LANCASTER AVE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "610-645-2494",
            "fax_number": "610-645-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE CANCER SPECIALISTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "DISTASIO",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "610-645-2494"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "PA",
            "license": "MC542764A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000279824",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "919262",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0094364000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Line Oncology Hematology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wynnewood, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.