NPIMap

Organization Active NPI

Scranton Quincy Clinic Company LLC

  • Podiatrist
  • Scranton, PA
National Provider Identifier
1902183304
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
SCRANTON QUINCY CLINIC COMPANY LLC
Practice address
748 Quincy Ave
Suite 1a
Scranton, PA 18510-1739
Phone
(570) 347-9600
Fax
(570) 342-0681
NPI assigned
Nov 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Authorized official

Name
Debbie Thorn Brewer
Title
Director
Phone
(877) 892-9813

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X
Foot Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0131X

Addresses

Primary practice location

748 Quincy Ave
Suite 1a
Scranton, PA 18510-1739

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (877) 309-5312

Other identifiers 1

IdentifierTypeStateIssuer
102669377-0002MedicaidPA

Other names 1

  • Physicians Health Alliance Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120131000544 PA Part B Supplier - Clinic/Group Practice 0143487389 Receives reassigned benefits from 131 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Scranton, PA; Wilkes Barre, PA; Plains, PA; Pittston, PA; Old Forge, PA; Hollidaysburg, PA; Forty Fort, PA; Dunmore, PA…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Physicians Health Alliance4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

748 Quincy Ave
Ste 1A
Scranton, PA 18510
Phone (570) 342-5253

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332374400000",
    "number": "1902183304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "877-309-5312",
            "fax_number": "615-465-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 QUINCY AVE",
            "address_2": "SUITE 1A",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185101739",
            "telephone_number": "570-347-9600",
            "fax_number": "570-342-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCRANTON QUINCY CLINIC COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2012-03-22",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "THORN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102669377-0002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; 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.