NPIMap

Individual provider Active NPI

Elis Milenova Ananieva, MD

  • Family Medicine Physician
  • Brodheadsville, PA
National Provider Identifier
1962071241
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD485675 Issued in PA
Practice address
120 Burrus Blvd Ste 200
Brodheadsville, PA 18322-7812
Phone
(570) 420-6300
NPI assigned
Jun 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT223583 PA
Family Medicine Physician 207Q00000X MD485675 PA Primary

Addresses

Primary practice location

120 Burrus Blvd Ste 200
Brodheadsville, PA 18322-7812

Mailing address

5501 Old York Rd
Philadelphia, PA 19141-3018

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
I20241011003608 PA Practitioner - Family Practice 6608308879 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

208 Kevin LN
Suite 101
Brodheadsville, PA 18322-7044
Phone (570) 992-7620

Hospital & facility affiliations

  • Lehigh Valley Home Care Home health agency, Allentown, PA, CCN 397023
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133
  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT223583PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group Family Medicine Current Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Sep 30, 2024 Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Sep 30, 2024 Accepting new patients
Pulmonary Associates PC Past Accepting new patients
Lehigh Valley Hospital Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

208 Kevin Ln
Ste 101
Brodheadsville, PA 18322
Phone (570) 992-7620

120 Burrus Blvd
Ste 200
Brodheadsville, PA 18322
Phone (570) 420-6300

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

Interoperability endpoints

  • Direct secure messaging: eananieva1127727@direct2.lvhn.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1962071241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BURRUS BLVD STE 200",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227812",
            "telephone_number": "570-420-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANANIEVA",
        "first_name": "ELIS",
        "middle_name": "MILENOVA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT223583",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD485675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brodheadsville, PA

Sources for this page

Verify at the official NPI Registry.