NPIMap

Organization Active NPI

Patina Medical Group, PC

  • Primary Care Clinic/Center
  • Bala Cynwyd, PA
National Provider Identifier
1801568910
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PATINA MEDICAL GROUP, PC
Practice address
150 Monument Rd
Bala Cynwyd, PA 19004-1702
Phone
(949) 246-3344
NPI assigned
Sep 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Alexandra Marie Ristow, MDNPI 1114361839
Title
Lead Primary Care Physician
Phone
(573) 999-7137

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

150 Monument Rd
Bala Cynwyd, PA 19004-1702

Mailing address

150 Monument Rd
Bala Cynwyd, PA 19004-1702
Phone (855) 478-8208

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230518003521 PA Part B Supplier - Clinic/Group Practice 2567828460 Receives reassigned benefits from 8 practitioners
Practice locations: Bala Cynwyd, PA

National Provider Directory

National Provider Directory

Locations

150 Monument Rd
Ste 500
Bala Cynwyd, PA 19004
Phone (800) 390-9321

Practitioners & affiliated clinicians

Practitioners 8

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": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1801568910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MONUMENT RD",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041702",
            "telephone_number": "855-478-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MONUMENT RD",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041702",
            "telephone_number": "949-246-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATINA MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "RISTOW",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "LEAD PRIMARY CARE PHYSICIAN",
        "authorized_official_telephone_number": "573-999-7137",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bala Cynwyd, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.