NPIMap

Organization Active NPI

Prime Healthcare Services-Roxborough Providers LLC

  • Psychologist
  • Philadelphia, PA
National Provider Identifier
1649525627
Registry record updated Apr 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PRIME HEALTHCARE SERVICES-ROXBOROUGH PROVIDERS LLC
Practice address
5800 Ridge Ave
Philadelphia, PA 19128-1737
Phone
(215) 509-6826
Fax
(215) 487-4274
NPI assigned
Jul 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2013

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

Authorized official

Name
Timothy C. Richards
Title
Authorized Representative
Phone
(215) 509-6826

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PA Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X PA

Addresses

Primary practice location

5800 Ridge Ave
Philadelphia, PA 19128-1737

Mailing address

5800 Ridge Ave
Philadelphia, PA 19128-1737
Phone (215) 509-6826

Other identifiers 1

IdentifierTypeStateIssuer
102765014MedicaidPA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

600 W Cheltenham Ave
Philadelphia, PA 19126
Phone (215) 509-6826

500 Ross St
#154045
Pittsburgh, PA 15219

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1649525627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191281737",
            "telephone_number": "215-509-6826",
            "fax_number": "215-487-4274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191281737",
            "telephone_number": "215-509-6826",
            "fax_number": "215-487-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES-ROXBOROUGH PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "215-509-6826"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102765014",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.