NPIMap

Organization Active NPI

Fornance Physician Services

Doing business as Family Practice Assoc of Kop of Fornance

  • Family Medicine Physician
  • King of Prussia, PA
National Provider Identifier
1609176544
Registry record updated Jun 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FORNANCE PHYSICIAN SERVICES
Doing business as
Family Practice Assoc of Kop of Fornance
Practice address
625 Clark Ave
Suite 13
King of Prussia, PA 19406-1438
Phone
(610) 265-8566
Fax
(610) 878-2620
NPI assigned
Oct 26, 2010
Last updated
Jun 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2017

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

Authorized official

Name
Vera Burnett-Robins
Title
Director Physician Billing
Phone
(484) 622-7391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

625 Clark Ave
Suite 13
King of Prussia, PA 19406-1438

Mailing address

625 Clark Ave
Suite 13
King of Prussia, PA 19406-1438
Phone (610) 265-8566

Other names 1

  • FAMILY PRACTICE ASSOC OF KOP OF FORNANCE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040216000037 PA Part B Supplier - Clinic/Group Practice 8527962661 Receives reassigned benefits from 215 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King of Prussia, PA; Lansdale, PA; Norristown, PA; North Wales, PA; Plymouth Meeting, PA; East Norriton, PA; Audubon, PA; Blue Bell, PA…

Other NPIs on the same Medicare enrollment 36

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 36

National Provider Directory

National Provider Directory

Locations

625 Clark Ave
Ste 13
Kng of Prussa, PA 19406
Phone (610) 265-8566

NPI Registry JSON

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497225600000",
    "number": "1609176544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLARK AVE",
            "address_2": "SUITE 13",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061438",
            "telephone_number": "610-265-8566",
            "fax_number": "610-878-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 CLARK AVE",
            "address_2": "SUITE 13",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061438",
            "telephone_number": "610-265-8566",
            "fax_number": "610-878-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORNANCE PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2017-06-12",
        "status": "A",
        "authorized_official_last_name": "BURNETT-ROBINS",
        "authorized_official_first_name": "VERA",
        "authorized_official_title_or_position": "DIRECTOR PHYSICIAN BILLING",
        "authorized_official_telephone_number": "484-622-7391"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY PRACTICE ASSOC OF KOP OF FORNANCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in King of Prussia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; 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.