| NPI |
1467941732 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Entity Type Code |
1 |
The date that a record was last updated or changed. |
| Provider Last Name Legal Name |
HABEEB |
The code designating the provider’s gender if the provider is a person. |
| Provider First Name |
RICHARD |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Middle Name |
EMIL |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Name Prefix Text |
DR. |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Credential Text |
MD |
|
| Provider First Line Business Practice Location Address |
620 HOWARD AVE |
|
| Provider Business Practice Location Address City Name |
ALTOONA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Business Practice Location Address State Name |
PA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address Postal Code |
166014804 |
|
| Provider Business Practice Location Address Country Code If outside U S |
US |
|
| Provider Business Practice Location Address Telephone Number |
8148892011 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider Enumeration Date |
5/2/2018 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Last Update Date |
8/10/2021 |
|
| Provider Gender Code |
M |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Healthcare Provider Taxonomy Code 1 |
390200000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
207R00000X |
|
| Provider License Number 2 |
MD474679 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 2 |
PA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
8/10/2021 |
|