NPIMap

Individual provider Active NPI

Jonathan Douglas Buckley, M.D.

  • Family Medicine Physician
  • Collegeville, PA
National Provider Identifier
1720221120
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD447233 Issued in PA
Practice address
599 Arcola Rd
Collegeville, PA 19426-3954
Phone
(484) 565-8440
NPI assigned
Apr 14, 2009
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD447233 PA
Family Medicine Physician 207Q00000X 24638 WV
Family Medicine Physician 207Q00000X MD447233 PA Primary

Addresses

Primary practice location

599 Arcola Rd
Collegeville, PA 19426-3954

Mailing address

599 Arcola Rd
Collegeville, PA 19426-3954
Phone (484) 565-8440

Other practice location 1

3200 MacCorkle Ave SE
Charleston, WV 25304-1227
Phone (304) 388-9948

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130305000401 PA Practitioner - Emergency Medicine 1759542095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

599 Arcola Rd
Collegeville, PA 19426-3954
Phone (484) 565-8440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD447233PAMDEmergency Medicine Physician
24638WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pottstown Clinic Company LLC Emergency Medicine CurrentSince Jan 1, 2020 Accepting new patients
Main Line Healthcare Family Medicine CurrentSince Feb 1, 2020 Accepting new patients
Greenbrier Emergency Services, Inc. Emergency Medicine Past Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

599 Arcola Rd
Collegeville, PA 19426
Phone (484) 565-8440

1600 E High St
Pottstown, PA 19464
Phone (610) 327-7485

730 S Hanover St
Pottstown, PA 19465
Phone (610) 323-6835

Organizations & group practices 3

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

Hospital & facility affiliations 7

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": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1720221120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 ARCOLA RD",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194263954",
            "telephone_number": "484-565-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 ARCOLA RD",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194263954",
            "telephone_number": "484-565-8440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 MacCorkle Ave SE",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041227",
            "country_code": "US",
            "telephone_number": "304-388-9948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JONATHAN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-14",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD447233",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "24638",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD447233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collegeville, PA

Sources for this page

Verify at the official NPI Registry.