NPIMap

Organization Active NPI

Intercommunity Action, Inc

  • Community/Behavioral Health Agency
  • Phila, PA
National Provider Identifier
1730224445
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INTERCOMMUNITY ACTION, INC
Practice address
6122 Ridge Ave
Phila, PA 19128-1603
Phone
(215) 487-1330
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Authorized official

Name
David Bolin
Title
Executive Director
Phone
(215) 487-0906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

6122 Ridge Ave
Phila, PA 19128-1603

Mailing address

6012 Ridge Ave
Phila, PA 19128-1643
Phone (215) 487-0906

Other identifiers 1

IdentifierTypeStateIssuer
1000008360083MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427000572 PA Part B Supplier - Clinic/Group Practice 2961499579 Receives reassigned benefits from 12 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Tax ID family
Intercommunity Action Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

538 Walnut Ln
Philadelphia, PA 19128
Phone (215) 487-1990

403 Rector St
Philadelphia, PA 19128
Phone (215) 487-1750

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1730224445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6012 RIDGE AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191281643",
            "telephone_number": "215-487-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6122 RIDGE AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191281603",
            "telephone_number": "215-487-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCOMMUNITY ACTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "BOLIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "215-487-0906"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000008360083",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.