NPIMap

Organization Active NPI

Pmsi Collegeville Family Practice

Doing business as Collegeville Family Practice

  • Family Medicine Physician
  • Collegeville, PA
National Provider Identifier
1942324330
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD046620L Issued in PA
Legal business name
PMSI COLLEGEVILLE FAMILY PRACTICE
Doing business as
Collegeville Family Practice
Practice address
555 Second Avenue
Suite 300
Collegeville, PA 19426
Phone
(610) 454-7750
Fax
(610) 454-1367
NPI assigned
Mar 19, 2007
Last updated
Jul 14, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLEGEVILLE FAMILY PRACTICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Authorized official

Name
Shana M Enochs
Title
Credentialing Specialist
Phone
(610) 327-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD046620L PA Primary

Addresses

Primary practice location

555 Second Avenue
Suite 300
Collegeville, PA 19426

Mailing address

555 Second Avenue
Suite 300
Collegeville, PA 19426
Phone (610) 454-7750

Other identifiers 2

IdentifierTypeStateIssuer
0045725015OtherPAKEYSTONE HMO
26191OtherPABLUE SHIELD ASSIGN ACCT

Other names 1

  • COLLEGEVILLE FAMILY PRACTICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000589 PA Part B Supplier - Clinic/Group Practice 8224024096 Receives reassigned benefits from 51 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boyertown, PA; Collegeville, PA; Pottstown, PA; Royersford, PA; Stowe, PA

Other NPIs on the same Medicare enrollment 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0978835Collegeville Family Practice555 Second Avenue Suite 300, Collegeville, PA 19426Certificate of waiverOct 3, 2026

National Provider Directory

National Provider Directory
Part of
Pottstown Meidcl Spec I

Locations

555 Second Ave
Collegeville, PA 19426
Phone (610) 454-7750

555 Second Ave
Ste 300
Collegeville, PA 19426
Phone (610) 454-7750

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1942324330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 SECOND AVENUE",
            "address_2": "SUITE 300",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "19426",
            "telephone_number": "610-454-7750",
            "fax_number": "610-454-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SECOND AVENUE",
            "address_2": "SUITE 300",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "19426",
            "telephone_number": "610-454-7750",
            "fax_number": "610-454-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMSI COLLEGEVILLE FAMILY PRACTICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLEGEVILLE FAMILY PRACTICE",
        "enumeration_date": "2007-03-19",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "ENOCHS",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "610-327-4200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD046620L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HMO",
            "identifier": "0045725015",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ASSIGN ACCT",
            "identifier": "26191",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLLEGEVILLE FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collegeville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.