Jan Neil Widerman, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS004029L Issued in PA

Practice address

10800 Bustleton Ave
Philadelphia, PA 19116-3302

Phone

(215) 934-6777

Fax

(215) 934-6787

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Jan N Widerman P.C.

  • Primary Care Clinic/Center
  • Philadelphia, PA
  • NPI 1962657346
  NPD (past) Authorized official

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1023197977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163302",
            "telephone_number": "215-934-6777",
            "fax_number": "215-934-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163302",
            "telephone_number": "215-934-6777",
            "fax_number": "215-934-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDERMAN",
        "first_name": "JAN",
        "middle_name": "NEIL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS004029L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Turner David Wibbelsman
• Kelsey Wible
• Kyle Gary Fitzgerald Wicker Jr., MD
• Alexis Inez Wickersham, M.D.
• Lori Lee Widener, LCSW
• Olivia Mae Widger, M.D.
• Crystal L Widmann, LPC
• Tracy Marie Widmer, CRNP
• Caryn S Widrick, MT-BC
• Julianne Leonarda Wiebalk, MS

• Pediatrics Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.

Verify at the official NPI Registry.