NPIMap

Organization Active NPI

Prospect Health Access Network, Inc.

  • Urology Physician
  • Drexel Hill, PA
National Provider Identifier
1982152294
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PROSPECT HEALTH ACCESS NETWORK, INC.
Practice address
2100 Keystone Ave
Drexel Hill, PA 19026-1129
Phone
(610) 259-3000
Fax
(610) 259-3042
NPI assigned
Sep 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

2100 Keystone Ave
Drexel Hill, PA 19026-1129

Mailing address

2100 Keystone Ave
Drexel Hill, PA 19026-1129
Phone (610) 259-3000

Other names 1

  • HAN Urology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160613000737 PA Part B Supplier - Clinic/Group Practice 5698065142 Receives reassigned benefits from 730 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory

Locations

175 E Chester Pike
Ridley Park, PA 19078
Phone (610) 595-6000

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1982152294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 KEYSTONE AVE",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261129",
            "telephone_number": "610-259-3000",
            "fax_number": "610-259-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 KEYSTONE AVE",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261129",
            "telephone_number": "610-259-3000",
            "fax_number": "610-259-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT HEALTH ACCESS NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAN Urology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HAN Urology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Drexel Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.