Organization Active NPI

Progressive Physician Assoc Inc

  • Diagnostic Radiology Physician
  • Bethlehem, PA
National Provider Identifier
1881646859
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PROGRESSIVE PHYSICIAN ASSOC INC
Practice address
95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424
Phone
(610) 868-1100
Fax
(610) 868-1111
NPI assigned
May 17, 2006
Last updated
Dec 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Authorized official

Name
Susanne Deangelo
Title
Administrative Credentialing Coordi
Phone
(610) 868-1100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X PA Primary
Vascular & Interventional Radiology Physician 2085R0204X PA
Vascular Surgery Physician 2086S0129X PA

Addresses

Primary practice location

95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424

Mailing address

95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424
Phone (610) 868-1100

Other identifiers 1

IdentifierTypeStateIssuer
1303700MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, NY, MA, GA, FL, NC, TX, MI, RI, DC, CT, OH, MS, IL, NM, CA, CO, DE, PR, SC, VT, VA, AZ, WA25 enrollments

Enrollment records 25

Enrollment IDStateProvider typePAC IDDetails
O20040123000977 PA Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 147 practitioners
2 other NPIs on this enrollment
Practice locations: Haverford, PA; Kennett Square, PA; Lehighton, PA; New Hope, PA; North Wales, PA; Orwigsburg, PA; Palmerton, PA; Perkiomenville, PA…
O20140312000133 NJ Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 134 practitioners
1 other NPI on this enrollment
Practice locations: Watchung, NJ; Basking Ridge, NJ; Warren, NJ; Ventnor City, NJ; Princeton, NJ; Phillipsburg, NJ; Moorestown, NJ; Livingston, NJ…
O20160204000224 NY Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 7 practitioners
Practice locations: Old Westbury, NY; New York, NY; Brooklyn, NY; Albertson, NY; Dix Hills, NY
O20171011000786 MA Part B Supplier - Clinic/Group Practice 1355243809 Practice locations: Provincetown, MA; Roxbury, MA
O20171027001315 GA Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 6 practitioners
Practice locations: Atlanta, GA; Decatur, GA; Johns Creek, GA; Norcross, GA; St Simons Island, GA
O20220103000945 FL Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 6 practitioners
Practice locations: Wilton Manors, FL; Tampa, FL; Plantation, FL; Delray Beach, FL; Marco Island, FL; Brandon, FL
O20220318000662 NC Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 5 practitioners
Practice locations: Cary, NC; Chapel Hill, NC; Charlotte, NC; Durham, NC
O20220321002298 TX Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 7 practitioners
Practice locations: Dallas, TX; Austin, TX; Sugar Land, TX; San Antonio, TX; Houston, TX
O20230222000305 MI Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Bloomfield Hills, MI; Southfield, MI
O20230419002826 RI Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: South Kingstown, RI
O20231101001742 DC Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Chevy Chase, MD; MC Lean, VA
O20231121000511 CT Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Riverside, CT
O20231201002794 OH Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Cleveland, OH
O20240108003894 MS Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Madison, MS; Ocean Springs, MS
O20240112000127 IL Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 3 practitioners
Practice locations: Highland Park, IL; Western Springs, IL; Winnetka, IL
O20240514000515 NM Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Fe, NM
O20240520001549 CA Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Vacaville, CA; La Jolla, CA
O20240626002899 CO Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Aurora, CO
O20250214002607 DE Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Middletown, DE
O20250321003383 PR Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Dorado, PR; San Juan, PR
O20250514001844 SC Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 2 practitioners
Practice locations: Daniel Island, SC; Mt Pleasant, SC
O20250708000822 VT Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Jericho, VT
O20251119004082 VA Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Keswick, VA
O20251215003080 AZ Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ
O20260429002390 WA Part B Supplier - Clinic/Group Practice 1355243809 Receives reassigned benefits from 1 practitioner
Practice locations: Seattle, WA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1837 W Linden St
Ste 1
Allentown, PA 18104
Phone (610) 366-7000

100 St Lukes Ln
Stroudsburg, PA 18360
Phone (272) 212-1000

Practitioners & affiliated clinicians

Practitioners 231

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 231

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1881646859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE",
            "address_2": "SUITE 130",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180179424",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE",
            "address_2": "SUITE 130",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180179424",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE PHYSICIAN ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "DEANGELO",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_title_or_position": "ADMINISTRATIVE CREDENTIALING COORDI",
        "authorized_official_telephone_number": "610-868-1100"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303700",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.