John Marcello Gentry, PSYD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS004299L Issued in PA

Practice address

928 Jaymor Rd
Suite B-150
Southampton, PA 18966-3826

Phone

(215) 947-8654

Fax

(215) 938-7607

NPI assigned

Jun 12, 2006

Last updated

Jun 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Delaware County Professional Services, IncGroup PAC ID 2668436692, 276 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Delaware County Professional Services, Inc

  dba LifeStance

  • Psychiatry Physician
  • Media, PA
  • NPI 1952485864
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1811939663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 JAYMOR RD",
            "address_2": "SUITE B-150",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663826",
            "telephone_number": "215-947-8654",
            "fax_number": "215-938-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 JAYMOR RD",
            "address_2": "SUITE B-150",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663826",
            "telephone_number": "215-947-8654",
            "fax_number": "215-938-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "JOHN",
        "middle_name": "MARCELLO",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS004299L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Gannon
• Isaac Anthony Garfield, LCSW
• Callista Jude Gartland
• Thomas J Gatley Jr., DDS
• Ashley Geevarghese
• Amy George, O.D
• Tintu George, CRNP
• Michael Gibilante I
• Michael Gill, LPC
• Caitlin Elizabeth Gilmartin, PSYD

• Clinical Child & Adolescent Psychologist in Southampton, PA
• Providers in Southampton, PA by specialty
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.