Active NPI
Kevin M Fosnocht, MD
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1003842709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD058278L
- Practice address
- 51 North 39TH Street
Mab, Suite 102
Philadelphia, PA 19104-2640 - Phone
- (215) 662-9990
- Fax
- (215) 243-3297
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD058278L | PA | Primary |
Addresses
Primary practice location
51 North 39TH Street
Mab, Suite 102
Philadelphia, PA 19104-2640
Mailing address
51 North 39TH Street
Mab, Suite 102
Philadelphia, PA 19104-2640
Phone (215) 662-9990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015950980002 | Medicaid | PA |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD058278L | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Penn - Medical Group | Internal Medicine | Current | Accepting new patients |
| University of Penn-Medical Group | Internal Medicine | Current | Accepting new patients |
| University of Penn-Medical Group | Current | Accepting new patients |
Locations
3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669
Organizations & group practices 3
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.
-
- Hospitalist Physician
- Philadelphia, PA
- NPI 1053447151
Internal Medicine
-
- Internal Medicine Physician
- Philadelphia, PA
- NPI 1386751089
-
- Surgical Oncology Physician
- Philadelphia, PA
- NPI 1871981985
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1003842709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 NORTH 39TH STREET",
"address_2": "MAB, SUITE 102",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-9990",
"fax_number": "215-243-3297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 NORTH 39TH STREET",
"address_2": "MAB, SUITE 102",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-9990",
"fax_number": "215-243-3297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSNOCHT",
"first_name": "KEVIN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD058278L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015950980002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.