Vital Health Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VITAL HEALTH PRIMARY CARE LLC

Practice address

930 Henrietta Ave Ste C
Huntingdon Valley, PA 19006-8523

Phone

(215) 663-9380

Fax

(215) 663-9383

NPI assigned

Aug 6, 2020

Organization subpart

No

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

Authorized official

Name

Jessly Alex, CRNPNPI 1235598210

Title

Authorized Signatory

Phone

(215) 738-2072

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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 3

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

• Jessly Alex, CRNP

  • Primary Care Nurse Practitioner
  • Huntingdon Valley, PA
  • NPI 1235598210
  Medicare reassignment NPD Authorized official
• Makram A Kalian, M.D.

  • Specialist
  • Huntingdon Valley, PA
  • NPI 1346203056
  NPD
• Eileen Hummel Simms, CRNP

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
  • NPI 1356447403
  NPD (past)

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1992315659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 PHEASANT DR",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190063036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 HENRIETTA AVE STE C",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190068523",
            "telephone_number": "215-663-9380",
            "fax_number": "215-663-9383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL HEALTH PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-06",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "ALEX",
        "authorized_official_first_name": "JESSLY",
        "authorized_official_title_or_position": "AUTHORIZED SIGNATORY",
        "authorized_official_telephone_number": "215-738-2072",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victory Ambulance, Inc.
• Victory Home Health Agency, Inc
• Joshua Vigderman, M.A., LPC
• Visual Eyes
• Vital Care Nurses LLC
• Daniel Vizak, D.P.T.
• Yulia N Voskoboynik, PHARMD.
• Kerry Walker
• Amy Wallwork, LMFT
• Michael J Walsh, PT

• Primary Care Clinic/Center in Huntingdon Valley, PA
• Providers in Huntingdon Valley, PA by specialty
• Primary Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.