NPIMap

Organization Active NPI

Primary Homecare, LLC

  • Primary Care Nurse Practitioner
  • Elkins Park, PA
National Provider Identifier
1629023593
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PRIMARY HOMECARE, LLC
Practice address
8118 Old York Rd
Suite D
Elkins Park, PA 19027-1423
Phone
(215) 635-3151
Fax
(215) 635-3165
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Authorized official

Name
Lisa Gill, DNP, CRNP
Title
Cco
Phone
(215) 635-3151

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

8118 Old York Rd
Suite D
Elkins Park, PA 19027-1423

Mailing address

8118 Old York Rd
Suite D
Elkins Park, PA 19027-1423
Phone (215) 635-3151

Other identifiers 2

IdentifierTypeStateIssuer
101916277 0001MedicaidPA
0018226880010MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000241 PA Part B Supplier - Clinic/Group Practice 3274437462 Receives reassigned benefits from 27 practitioners
Practice locations: Bristol, PA; Elkins Park, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1070524Primary Homecare LLC8118 Old York Road Suite D, Elkins Park, PA 19027Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory

Locations

318 S Burnt Mill Rd
Ste 200
Voorhees, NJ 08043
Phone (215) 635-3151

2480 Durham Rd
Bristol, PA 19007
Phone (215) 949-3200

2480 Durham Rd
#B
Bristol, PA 19007
Phone (215) 635-3151

1337A Cottman Ave
Philadelphia, PA 19111
Phone (215) 722-7835

Practitioners & affiliated clinicians

Practitioners 58

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

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1629023593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8118 OLD YORK RD",
            "address_2": "SUITE D",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271423",
            "telephone_number": "215-635-3151",
            "fax_number": "215-635-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8118 OLD YORK RD",
            "address_2": "SUITE D",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271423",
            "telephone_number": "215-635-3151",
            "fax_number": "215-635-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "215-635-3151",
        "authorized_official_credential": "DNP, CRNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101916277 0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018226880010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkins Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.