NPIMap

Organization Active NPI

Pmsi Division of Nephrology

  • Nephrology Physician
  • Pottstown, PA
National Provider Identifier
1679698401
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD438936
Legal business name
PMSI DIVISION OF NEPHROLOGY
Practice address
1591 Medical Drive
Pottstown, PA 19464
Phone
(610) 326-8005
Fax
(484) 945-0509
NPI assigned
Mar 20, 2007
Last updated
Jul 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Authorized official

Name
Shana M Enochs
Title
Credentialing Specialist
Phone
(610) 327-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X MD438936 Primary

Addresses

Primary practice location

1591 Medical Drive
Pottstown, PA 19464

Mailing address

1610 Medical Drive
Suite 310
Pottstown, PA 19464
Phone (610) 327-4200

Other identifiers 3

IdentifierTypeStateIssuer
919349OtherPAPA BLUE SHIELD
0860002000OtherPAKEYSTONE HMO
0007964850006MedicaidPA

Other names 1

  • POTTSTOWN MEDICAL SPECIALISTS NEPHROLOGY Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000589 PA Part B Supplier - Clinic/Group Practice 8224024096 Receives reassigned benefits from 51 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boyertown, PA; Collegeville, PA; Pottstown, PA; Royersford, PA; Stowe, PA

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1679698401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 MEDICAL DRIVE",
            "address_2": "SUITE 310",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "19464",
            "telephone_number": "610-327-4200",
            "fax_number": "610-327-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1591 MEDICAL DRIVE",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "19464",
            "telephone_number": "610-326-8005",
            "fax_number": "484-945-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMSI DIVISION OF NEPHROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "ENOCHS",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "610-327-4200"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": "MD438936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD",
            "identifier": "919349",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HMO",
            "identifier": "0860002000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007964850006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTTSTOWN MEDICAL SPECIALISTS NEPHROLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pottstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.