NPIMap

Organization Active NPI

Edward Burnetta MD LLC

  • Specialist
  • Bryn Mawr, PA
National Provider Identifier
1780717546
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD059218L Issued in PA
Legal business name
EDWARD BURNETTA MD LLC
Practice address
5017 Brittany LN
Bryn Mawr, PA 19010-2079
Phone
(610) 247-9830
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Edward Burnetta, MDNPI 1689696486
Title
Physiatrist
Phone
(610) 247-9830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD059218L PA Primary

Addresses

Primary practice location

5017 Brittany LN
Bryn Mawr, PA 19010-2079

Mailing address

5017 Brittany LN
Bryn Mawr, PA 19010-2079
Phone (610) 247-9830

Other identifiers 1

IdentifierTypeStateIssuer
0073081140001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070409000088 PA Part B Supplier - Clinic/Group Practice 2668576265 Receives reassigned benefits from 11 practitioners
Practice locations: Bryn Mawr, PA; Elkins Park, PA; Media, PA; Philadelphia, PA; Villanova, PA

National Provider Directory

National Provider Directory

Locations

905 Tower Rd
Bristol, PA 19007
Phone (215) 785-2109

14 Lincoln Ave
Yeadon, PA 19050
Phone (610) 626-7700

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780717546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 BRITTANY LN",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190102079",
            "telephone_number": "610-247-9830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 BRITTANY LN",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190102079",
            "telephone_number": "610-247-9830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD BURNETTA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURNETTA",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSIATRIST",
        "authorized_official_telephone_number": "610-247-9830",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD059218L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0073081140001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.