Martene Jacqueline Imboden, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA059556 Issued in PA

Practice address

701 Ostrum St Ste 603
Fountain Hill, PA 18015-1184

Phone

(484) 526-3990

Fax

(610) 868-2915

NPI assigned

Jan 2, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• St Luke'S Physician Group Inc

  • Family Medicine Physician
  • Orwigsburg, PA
  • NPI 1710845144
  NPD
• St. Luke'S Physician Group, Inc.

  • Obstetrics & Gynecology Physician
  • Allentown, PA
  • NPI 1043306756
  NPD

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515369600000",
    "number": "1992212708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST STE 603",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151184",
            "telephone_number": "484-526-3990",
            "fax_number": "610-868-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST STE 603",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151184",
            "telephone_number": "484-526-3990",
            "fax_number": "610-868-2915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Ostrum St Ste 603",
            "address_purpose": "LOCATION",
            "city": "Fountain Hill",
            "state": "PA",
            "postal_code": "180151184",
            "country_code": "US",
            "telephone_number": "484-526-3990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMBODEN",
        "first_name": "MARTENE",
        "middle_name": "JACQUELINE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA059556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Horwath
• Hovertech Ineternational
• Howard K. Horne, MD
• Andrea Huncharoff
• Girma Gutema Hundie, PHYSICIAN ASSISTANCE
• Caroline Alexis Interrante, M.D.
• John Interrante, M.D.
• Natasha Nour Ireifej, PA-C
• Ibrahim Ismail-Sayed, MD
• Karyn J. Israel, M.D.

• Surgical Physician Assistant in Fountain Hill, PA
• Providers in Fountain Hill, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.