Active NPI
Ivyland Medical Center
- Family Medicine Physician
- Warminster, PA
National Provider Identifier
1720057474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD071701L
- Legal business name
- IVYLAND MEDICAL CENTER
- Practice address
- 1035 W Bristol Rd
Suite B
Warminster, PA 18974-1009 - Phone
- (215) 442-9929
- Fax
- (215) 442-9927
- NPI assigned
- Mar 15, 2006
- Last updated
- Feb 17, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Brad Paddock, MD
- Title
- Owner
- Phone
- (215) 442-9929
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD071701L | PA | Primary |
Addresses
Primary practice location
1035 W Bristol Rd
Suite B
Warminster, PA 18974-1009
Mailing address
1035 W Bristol Rd
Suite B
Warminster, PA 18974-1009
Phone (215) 442-9929
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2864291 | Other | PA | AETNA/US HEALTHCARE |
| 30004076 | Other | PA | KEYSTONE MERCY HEALTHPLAN |
| IV1401548 | Other | PA | BLUE SHIELD OF PA |
| 2090073001 | Other | PA | INDEPENDENCE BLUE CROSS |
| 0078015690002 | Medicaid | PA |
National Provider Directory
National Provider DirectoryLocations
1035 W Bristol Rd
Ste B
Warminster, PA 18974
Phone (215) 442-9929
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1266364800000",
"number": "1720057474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 W BRISTOL RD",
"address_2": "SUITE B",
"city": "WARMINSTER",
"state": "PA",
"postal_code": "189741009",
"telephone_number": "215-442-9929",
"fax_number": "215-442-9927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 W BRISTOL RD",
"address_2": "SUITE B",
"city": "WARMINSTER",
"state": "PA",
"postal_code": "189741009",
"telephone_number": "215-442-9929",
"fax_number": "215-442-9927"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IVYLAND MEDICAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-15",
"last_updated": "2010-02-17",
"status": "A",
"authorized_official_last_name": "PADDOCK",
"authorized_official_first_name": "BRAD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "215-442-9929",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "PA",
"license": "MD071701L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA/US HEALTHCARE",
"identifier": "2864291",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTHPLAN",
"identifier": "30004076",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF PA",
"identifier": "IV1401548",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "2090073001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0078015690002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warminster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.