Individual provider Active NPI

Carlo J Pelino, OD

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1003917378
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000913 Issued in PA
Practice address
1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone
(215) 276-6000
Fax
(215) 276-1329
NPI assigned
Sep 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG000913 PA Primary

Addresses

Primary practice location

1200 W Godfrey Ave
Philadelphia, PA 19141-3323

Mailing address

500 West Ave
Apt B14
Jenkintown, PA 19046-2726
Phone (215) 421-3241

Other identifiers 2

IdentifierTypeStateIssuer
0459326000OtherPAKEYSTONE EAST
05571OtherPABLUE SHIELD

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100709000532 PA Practitioner - Optometry 6709918733 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Drexel UniversityGroup PAC ID 5496664740, 80 clinicians

Practice addresses (Care Compare)

1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone (215) 276-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG000913PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Drexel University CurrentSince Dec 28, 2024 Accepting new patients
Salus University Hearing Vision Balance Clinic Optometrist CurrentSince Nov 15, 2000 Accepting new patients
Delaware Valley Community Health, Inc. CurrentSince Mar 22, 2018 Accepting new patients
Drexel University Optometrist CurrentSince Nov 15, 2000 Accepting new patients
Drexel University CurrentSince Dec 28, 2024 Accepting new patients
Delaware Valley Community Health, Inc. CurrentSince Mar 22, 2018 Accepting new patients
Drexel University Current Accepting new patients

Locations

1401 DeKalb St
Norristown, PA 19401
Phone (610) 275-9400

1200 W Godfrey Ave
Philadelphia, PA 19141
Phone (215) 276-6000

1412 Fairmount Ave
Philadelphia, PA 19130
Phone (215) 235-9600

1427 Vine St
Fl 2
Philadelphia, PA 19102
Phone (215) 762-2530

1427 Vine St
Fl 8
Philadelphia, PA 19102
Phone (215) 762-6660

7630 Germantown Ave
Ste 4
Philadelphia, PA 19118
Phone (215) 276-6000

Interoperability endpoints

  • Direct secure messaging: carlo.pelino.p1@direct.dvch.nextgenshare.com
  • Direct secure messaging: carlo.pelino.p1@direct.salusuhealth.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003917378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WEST AVE",
            "address_2": "APT B14",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190462726",
            "telephone_number": "215-421-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-1329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELINO",
        "first_name": "CARLO",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE EAST",
            "identifier": "0459326000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "05571",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.