NPIMap

Individual provider Active NPI

John Martin Andersen, MD

  • Family Medicine Physician
  • Potts, PA
National Provider Identifier
1891801981
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD 039149E Issued in PA
Practice address
933 N Charlotte Street
3-A
Potts, PA 19464-3974
Phone
(610) 323-9052
Fax
(610) 323-3085
NPI assigned
Aug 22, 2006
Last updated
Oct 17, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD 039149E PA Primary

Addresses

Primary practice location

933 N Charlotte Street
3-A
Potts, PA 19464-3974

Mailing address

933 N Charlotte Street
3-A
Potts, PA 19464-3974
Phone (610) 323-9052

Other identifiers 11

IdentifierTypeStateIssuer
232925465OtherBLUE CROSS OF DE
000506727OtherINDEPENDENCE BLUE CROSS
1025953OtherKEYSTONEMERCY HEALTH PLAN
000506727OtherHIGHMARK BLUE CROSS
000506727OtherBLUE CROSS BLUE SHIELD
0109636001OtherPAKHPE/IBC
232925465OtherBERKSHIRE HEALTH PLANS
000506727OtherCAPITAL BLUE CROSS
232925465OtherCOVENTRY HEALTHCARE OF DE
0011067390001MedicaidPA
018149OtherPAAETNA HMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100519000657 PA Practitioner - Family PracticePractitioner - Geriatric Medicine 2365571940 Practice locations: Pottstown, PA

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University Central del Caribe Escuela de Medicina, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

933 N Charlotte St
Pottstown, PA 19464-3974

933 N Charlotte Street
Pottstown, PA 19464-3974
Phone (610) 323-9052

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue49
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD 039149EPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
724 N Charlotte Street Operations LLC Past Accepting new patients
John M. Andersen M.D. Family Medicine Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1891801981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 N CHARLOTTE STREET",
            "address_2": "3-A",
            "city": "POTTS",
            "state": "PA",
            "postal_code": "194643974",
            "telephone_number": "610-323-9052",
            "fax_number": "610-323-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 N CHARLOTTE STREET",
            "address_2": "3-A",
            "city": "POTTS",
            "state": "PA",
            "postal_code": "194643974",
            "telephone_number": "610-323-9052",
            "fax_number": "610-323-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JOHN",
        "middle_name": "MARTIN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD 039149E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF DE",
            "identifier": "232925465",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "000506727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONEMERCY HEALTH PLAN",
            "identifier": "1025953",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE CROSS",
            "identifier": "000506727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000506727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KHPE/IBC",
            "identifier": "0109636001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BERKSHIRE HEALTH PLANS",
            "identifier": "232925465",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "000506727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTHCARE OF DE",
            "identifier": "232925465",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011067390001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "018149",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.