Individual provider Active NPI

Nicholas Kian Mollanazar, MD, MBA

  • Dermatology Physician
  • Philadelphia, PA
National Provider Identifier
1003201617
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD467873 Issued in PA
Practice address
800 Spruce Street
10TH Floor
Philadelphia, PA 19107-5701
Phone
(941) 718-8997
NPI assigned
Mar 31, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD467873 PA Primary

Addresses

Primary practice location

800 Spruce Street
10TH Floor
Philadelphia, PA 19107-5701

Mailing address

3400 Civic Center Blvd
1St Floor, Derm
Philadelphia, PA 19104-5127
Phone (941) 718-8997

Other practice location 1

3400 Civic Center Boulevard
South Pavilion 1st floor
Philadelphia, PA 19104
Phone (215) 662-7366

Other practice location 2

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3376

Other practice location 3

3400 Spruce St
2 Maloney Building
Philadelphia, PA 19104
Phone (215) 662-7366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190725000607 PA Practitioner - Dermatology 9739415985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Temple University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Suite 1 330S
Philadelphia, PA 19104-5132
Phone (215) 662-2737

Hospital & facility affiliations

  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions595
Removal of skin cancer1-10
Removal of nail tissue1-10
Removal or shaving of skin growth36
Skin biopsy375

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD467873PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Aug 1, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 1, 2019 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3400 Civic Center Blvd
Ste 1-330S
Philadelphia, PA 19104
Phone (215) 360-0909

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

3400 Civic Center Blvd
Fl 1
Philadelphia, PA 19104
Phone (215) 615-5864

800 Spruce St
Fl 10
Philadelphia, PA 19107
Phone 2157327600102

235 S 8th St
Philadelphia, PA 19106
Phone (215) 543-2770

3400 Spruce St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-2428

1000 Floral Vale Blvd
Yardley, PA 19067
Phone (215) 752-4020

Networks

  • devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
  • devoted network organization-8ee96498-f86e-45f6-9fc9-a0f06c1636f9
  • devoted network organization-2d523d8e-e8f9-454a-bcd3-333df65bdbe8
  • OH PPO
  • devoted network organization-9f3dfbd3-4aa6-4c92-8e71-9c4ed35ce037

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1003201617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1ST FLOOR, DERM",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "941-718-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SPRUCE STREET",
            "address_2": "10TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075701",
            "telephone_number": "941-718-8997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Civic Center Boulevard",
            "address_2": "South Pavilion 1st floor",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-662-7366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-3376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3400 Spruce St",
            "address_2": "2 Maloney Building",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-662-7366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLLANAZAR",
        "first_name": "NICHOLAS",
        "middle_name": "KIAN",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-31",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD467873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.