Basic Information
Provider Information | |||||||||
NPI: | 1700069101 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BACASNOT | ||||||||
FirstName: | JEROME | ||||||||
MiddleName: | VINCENT VENTURINA | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1803 MOUNT ROSE AVE | ||||||||
Address2: | SUITE B3 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033051 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7178516969 | ||||||||
Practice Location | |||||||||
Address1: | 1001 S GEORGE ST | ||||||||
Address2: | YORK HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033676 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512450 | ||||||||
FaxNumber: | 7178513469 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/10/2007 | ||||||||
LastUpdateDate: | 03/23/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD434659 | PA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 20076940 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 211500 | 01 | PA | JOHNS HOPKINS | OTHER | 102168935 | 05 | PA |   | MEDICAID | 118663 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 50079323 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 248111 | 01 | PA | UNISON-WMG | OTHER | 9864197 | 01 | PA | AETNA | OTHER | 1572369 | 01 | PA | GATEWAY-WMG | OTHER | 2067460 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |