NPIMap

Organization Active NPI

Mercy Catholic Medical Center of Southeastern PA

Doing business as Mercy Fitzgerald Hospital Short Procedure Unit

  • Ambulatory Surgical Clinic/Center
  • Darby, PA
National Provider Identifier
1699815811
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Doing business as
Mercy Fitzgerald Hospital Short Procedure Unit
Practice address
1500 Lansdowne Ave
Darby, PA 19023-1200
Phone
(610) 237-4000
NPI assigned
Feb 7, 2007
Last updated
Jun 16, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Mr. Douglas C. Smith
Title
Vice President
Phone
(610) 567-6601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1500 Lansdowne Ave
Darby, PA 19023-1200

Mailing address

1 W Elm St
Suite 100
Conshohocken, PA 19428-2007
Phone (610) 567-6000

Other names 1

  • Mercy Fitzgerald Hospital Short Procedure Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081010000102 PA Part A Provider - Hospital 3678476561 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Darby, PA; Philadelphia, PA; Havertown, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699815811. Details of each certification follow.

Hospital certification: CCN 390156B

Legal name
MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Doing business as
MERCY CATHOLIC MEDICAL CENTER - MERCY FITZGERALD HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Oct 29, 1968 in PA
Enrollment address
1500 Lansdowne Ave
Mercy Fitzgerald Hospital
Darby, PA 19023-1291
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Short-term, Psychiatric unit, Rehabilitation unit

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Catholic Ekg Asso19 organizations share this tax ID, including this one
Part of
Mercy Catholic Ekg Asso

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

2010 W Chester Pike
Ste 438
Havertown, PA 19083
Phone (215) 748-9233

2821 Island Ave
Ste E
Philadelphia, PA 19153
Phone (215) 863-2301

5249 Cedar Ave
#B
Philadelphia, PA 19143
Phone (215) 748-9740

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marianne Grace Individual Corporate DirectorBoard Member Jul 1, 2019
Geraldine Hoyler Individual Corporate DirectorBoard Member Jan 1, 2026
James M Monihan Individual Corporate DirectorBoard Member Jul 1, 2020
Julie Keese Individual Contracted Managing EmployeeVice President Finance and Cfo Jun 21, 2025
Corporate OfficerTreasurer Jun 21, 2002
Sandra Lynn Kweder Individual Corporate DirectorBoard Member Jan 1, 2025
Jacqueline a Watson Individual Corporate DirectorBoard Member Jan 1, 2025
Julie Washington Individual Corporate DirectorBoard Member Jul 1, 2020
Ajay K Gupta Individual Corporate OfficerVice-Chair Jan 1, 2026
Corporate DirectorBoard Member Jan 1, 2025
Barbara Buckley Individual Corporate DirectorBoard Member Jul 1, 2021
Larry Warren Individual Corporate DirectorBoard Member Jan 1, 2025
Robin W Madden Individual Corporate DirectorBoard Member Jan 1, 2025
Laura Williams Individual Corporate OfficerRegional Manager of Medical Group Jan 1, 2025
W-2 Managing EmployeeRegional Manager of Medical Group Jan 1, 2025
Andre Boyd Individual Corporate OfficerPresident and Ceo Jan 6, 2025
Corporate DirectorBoard Member Jan 6, 2025
Hiral P Fontanilla Individual Corporate DirectorBoard Member Jan 1, 2022
Michelle Calope Individual Corporate DirectorBoard Member Jan 1, 2023
Jacqueline Blong Individual Corporate OfficerDir of Finance Operations Jul 1, 2021
W-2 Managing EmployeeDirector of Finance Jul 1, 2021
Marlow Levy Individual Corporate OfficerPresident Sep 4, 2024
W-2 Managing EmployeePresident Sep 4, 2024
Shaila Kapur Individual Corporate DirectorBoard Member Jul 1, 2020
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest May 1, 2013 100%
Carmen O Larsen Individual Corporate DirectorBoard Member Jan 1, 2025
Trinity Health of the Mid-Atlantic Region Organization, Newtown Square, PA Created for acquisition, Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2019 100%
Vincent D Gordon Individual Corporate OfficerChair Jan 1, 2026
Corporate DirectorBoard Member Jan 1, 2025
Catherine Mikus Individual Corporate OfficerSecretary Jul 1, 2021

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1699815811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W ELM ST",
            "address_2": "SUITE 100",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282007",
            "telephone_number": "610-567-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LANSDOWNE AVE",
            "city": "DARBY",
            "state": "PA",
            "postal_code": "190231200",
            "telephone_number": "610-237-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "610-567-6601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Fitzgerald Hospital Short Procedure Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Darby, PA

Sources for this page

Verify at the official NPI Registry.