NPIMap

Organization Active NPI

Prospect Health Access Network, Inc.

  • Geriatric Medicine (Family Medicine) Physician
  • Crum Lynne, PA
National Provider Identifier
1619322112
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
PROSPECT HEALTH ACCESS NETWORK, INC.
Practice address
1553 Chester Pike Ste 101
Crum Lynne, PA 19022-1022
Phone
(610) 447-2000
NPI assigned
May 3, 2016
Last updated
Oct 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU Primary

Addresses

Primary practice location

1553 Chester Pike Ste 101
Crum Lynne, PA 19022-1022

Mailing address

1553 Chester Pike Ste 101
Crum Lynne, PA 19022-1022
Phone (610) 447-2000

Other names 1

  • Family Medicine Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160613000737 PA Part B Supplier - Clinic/Group Practice 5698065142 Receives reassigned benefits from 730 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory

Locations

30 Lawrence Rd
Ste 100
Broomall, PA 19008
Phone (484) 446-3588

1553 Chester Pike
Ste 101
Crum Lynne, PA 19022
Phone (610) 522-2822

176 S New Middletown Rd
Media, PA 19063
Phone (610) 627-3690

Interoperability endpoints

  • Direct secure messaging: aleshia.crump@chpm.cernerdirect.com
  • Direct secure messaging: allison.hannan@chpm.cernerdirect.com
  • Direct secure messaging: anne.donnelly@chpm.cernerdirect.com
  • Direct secure messaging: aradhana.ishwar@chpm.cernerdirect.com
  • Direct secure messaging: ashu.singh@chpm.cernerdirect.com
  • Direct secure messaging: candace.nguyen@chpm.cernerdirect.com
  • Direct secure messaging: christine.oh@chpm.cernerdirect.com
  • Direct secure messaging: chrystine.palomba@chpm.cernerdirect.com
  • Direct secure messaging: colin.turney@chpm.cernerdirect.com
  • Direct secure messaging: cynthia.sacharok@chpm.cernerdirect.com
  • Direct secure messaging: david.broyles@chpm.cernerdirect.com
  • Direct secure messaging: david.trinkley@chpm.cernerdirect.com
  • Direct secure messaging: deborah.longo-malloy@chpm.cernerdirect.com
  • Direct secure messaging: dina.capalongo@chpm.cernerdirect.com
  • Direct secure messaging: donna.delfin@chpm.cernerdirect.com
  • Direct secure messaging: elena.kazlo@chpm.cernerdirect.com
  • Direct secure messaging: erica.sturdivant@chpm.cernerdirect.com
  • Direct secure messaging: genevieve.minick@chpm.cernerdirect.com
  • Direct secure messaging: jacqueline.scheier@chpm.cernerdirect.com
  • Direct secure messaging: janet.fontanella@chpm.cernerdirect.com

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1619322112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 CHESTER PIKE STE 101",
            "city": "CRUM LYNNE",
            "state": "PA",
            "postal_code": "190221022",
            "telephone_number": "610-447-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 CHESTER PIKE STE 101",
            "city": "CRUM LYNNE",
            "state": "PA",
            "postal_code": "190221022",
            "telephone_number": "610-447-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT HEALTH ACCESS NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Crum Lynne, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.