NPIMap

Individual provider Active NPI

Eric Soult

  • Medical Physician Assistant
  • Fogelsville, PA
National Provider Identifier
1669916557
Registry record updated Sep 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
OA004644 Issued in PA
Practice address
1431 Nursery St Ste 101
Fogelsville, PA 18051-1612
Phone
(484) 273-4343
NPI assigned
Dec 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00412000 NJ
Medical Physician Assistant 363AM0700X OA004644 PA Primary

Addresses

Primary practice location

1431 Nursery St Ste 101
Fogelsville, PA 18051-1612

Mailing address

2100 Mack Blvd
Allentown, PA 18103-5622
Phone (484) 884-4500

Other practice location 1

108 Ridgeway St
Mount Holly, NJ 08060-1440
Phone (609) 284-7312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170207000378 NJ Practitioner - Physician Assistant 4587947148 Reassigns benefits to 1 organization
I20180214000771 PA Practitioner - Physician Assistant 4587947148 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

101 W 7TH St
Pennsburg, PA 18073-1512

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

1431 Nursery St
Fogelsville, PA 18051-1612

14351 Kutztown Rd
Fleetwood, PA 19522-9273
Phone (610) 944-8800

1791 Airport Rd
Allentown, PA 18109-9528
Phone (484) 240-8195

200 Schuylkill Medical PLZ
Pottsville, PA 17901-3660
Phone (570) 621-9270

320 W Pumping Station Rd
Quakertown, PA 18951-2345

320 W Pumping Station Road
3 LVPG Family Medicine Richland Township
Quakertown, PA 18951-2345
Phone (215) 529-4240

Hospital & facility affiliations

  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
OA004644PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hazleton Professional Services CurrentSince Sep 30, 2024 Accepting new patients
Lehigh Valley Physician Group CurrentSince Sep 5, 2024 Accepting new patients
Lehigh Valley Physician Group CurrentSince Sep 5, 2024 Accepting new patients
Custom Sleep Therapies PC PastSince Sep 5, 2021 Accepting new patients

Locations

2100 Mack Blvd
Allentown, PA 18103
Phone (484) 224-1892

1000 Alliance Dr
#10
Hazleton, PA 18202
Phone (570) 501-6450

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

320 W Pumping Station Rd
Quakertown, PA 18951
Phone (215) 529-4240

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1669916557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "484-884-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 NURSERY ST STE 101",
            "city": "FOGELSVILLE",
            "state": "PA",
            "postal_code": "180511612",
            "telephone_number": "484-273-4343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Ridgeway St",
            "address_purpose": "LOCATION",
            "city": "Mount Holly",
            "state": "NJ",
            "postal_code": "080601440",
            "country_code": "US",
            "telephone_number": "609-284-7312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOULT",
        "first_name": "ERIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-12",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00412000",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA004644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fogelsville, PA

Sources for this page

Verify at the official NPI Registry.