Providence Pediatric Practice LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PROVIDENCE PEDIATRIC PRACTICE LLC

Practice address

100 Granite Dr
Suite 200
Media, PA 19063-5134

Phone

(610) 565-1945

Fax

(610) 892-7848

NPI assigned

Mar 31, 2006

Organization subpart

No

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

Authorized official

Name

Jacquelyn H Gibbons, MD

Title

Physician Senior Partner

Phone

(610) 565-1945

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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

• Olivia Theresa Dimaggio, MD

  • Pediatrics Physician
  • Media, PA
  • NPI 1316908031
  NPD (past)
• Alison Gaudet, M.D.

  • Pediatrics Physician
  • Media, PA
  • NPI 1215998380
  NPD (past)
• Allison R Horowitz, M.D.

  • Pediatrics Physician
  • Media, PA
  • NPI 1346401155
  NPD (past)
• Betsy G Race, MD

  • Pediatrics Physician
  • Media, PA
  • NPI 1710948401
  NPD (past)
• Lisa Renee Di Enno, M.D.

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1407050297
  NPD (past)
• Maeve Mersman, MD

  • Student in an Organized Health Care Education/Training Program
  • Camden, NJ
  • NPI 1689314601
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1932160629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GRANITE DR",
            "address_2": "SUITE 200",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635134",
            "telephone_number": "610-565-1945",
            "fax_number": "610-892-7848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GRANITE DR",
            "address_2": "SUITE 200",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635134",
            "telephone_number": "610-565-1945",
            "fax_number": "610-892-7848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PEDIATRIC PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICIAN SENIOR PARTNER",
        "authorized_official_telephone_number": "610-565-1945",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Pain Managment Associates, PC
• John A Pron, DPM
• Prospect CCMC, LLC
• Providence Ear Nose & Throat Associates Inc
• Providence Living LLC (Providence Treatment)
• Pulmonary Care Associates LTD
• Pulmonary Critical Care & Sleep Physicians of the Main Line PC
• Pulmonary Critical Care and Sleep Associates, P.C.
• Audrey Purins
• Qrst2 LLC (Quick Response Medical Transport)

• Pediatrics Physician in Media, PA
• Providers in Media, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.