Alex Johnson Addo

NPI1841685054

Summary

Provider Details

NPI Number 1841685054
Provider Name Alex Johnson Addo
Credential
Specialization
Medical School Name Tufts University School Of Medicine
Graduation Year 2015
Gender M
Entity Type Individual
PAC ID by PECOS 7416251400
Professional Enrollment ID I20191227000003
Enumeration Date 04/03/2015
Last Update Date 04/03/2015

Contact Details

Business Practice address 100 N ACADEMY AVE, Danville,
17822-9800 Pennsylvania View on Google Map
Business Practice phone 651-592-2766
Business Practice fax
Mailing address 39 GLEN RD # 1, Jamaica Plain,
02130-3340 Massachusetts View on Google Map
Other phone 651-592-2766
Other fax
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Alex Johnson Addo Update NPI

Hospital Affilitation

Practices in Danville

Danville, Pennsylvania

Education & Training

Tufts University School Of Medicine

2015

Group Affiliation

Organization Name PECOS PAC ID Members
Luminis Health Medical Group, Llc 2860447315 337
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1841685054
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Addo
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Alex
The first name of the provider, if the provider is an individual.
Provider Credential Text
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 39 GLEN RD # 1
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Jamaica Plain
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Massachusetts
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 02130-3340
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 651-592-2766
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider First Line Business Practice Location Address 100 N ACADEMY AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Danville
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Pennsylvania
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 17822-9800
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 651-592-2766
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date 04/03/2015
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 04/03/2015
The date that a record was last updated or changed.
Provider Gender Code M
The code designating the provider's gender if the provider is a person.
Provider Gender Male
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 390200000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Healthcare Provider Taxonomy #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.