NPIMap

Organization Active NPI

Trinity Health Mid-Atlantic Medical Group

  • Family Medicine Physician
  • Richboro, PA
National Provider Identifier
1609260397
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Practice address
95 Almshouse Rd
Suite 103
Richboro, PA 18954-1154
Phone
(215) 357-5760
Fax
(215) 357-5731
NPI assigned
Mar 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

Name
Ms. Sharon Profera
Title
Administrative Director
Phone
(215) 710-2013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

95 Almshouse Rd
Suite 103
Richboro, PA 18954-1154

Mailing address

41 University Dr
Suite 300
Newtown, PA 18940-1873
Phone (215) 710-7037

Other identifiers 6

IdentifierTypeStateIssuer
1007497370052MedicaidPA
4196193OtherPAAETNA
3156947OtherPAHIGHMARK BLUE SHIELD
30212269OtherPAKEYSTONE FIRST
3920999003OtherPAKEYSTONE IBC
CA4059OtherPARAILROAD MEDICARE

Other names 1

  • St. Mary Family Practice - Richboro Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000613 PA Part B Supplier - Clinic/Group Practice 7416861885 Receives reassigned benefits from 703 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

95 Almshouse Rd
Ste 103
Richboro, PA 18954
Phone (215) 357-5760

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1609260397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 UNIVERSITY DR",
            "address_2": "SUITE 300",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189401873",
            "telephone_number": "215-710-7037",
            "fax_number": "215-710-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 ALMSHOUSE RD",
            "address_2": "SUITE 103",
            "city": "RICHBORO",
            "state": "PA",
            "postal_code": "189541154",
            "telephone_number": "215-357-5760",
            "fax_number": "215-357-5731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "PROFERA",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "215-710-2013",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007497370052",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4196193",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "3156947",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE FIRST",
            "identifier": "30212269",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE IBC",
            "identifier": "3920999003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA4059",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary Family Practice - Richboro",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary Family Practice - Richboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.