NPIMap

Organization Active NPI

St.Chris Care at Northeast Pediatrics, LLC

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1043379506
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ST.CHRIS CARE AT NORTHEAST PEDIATRICS, LLC
Practice address
9501 Roosevelt Blvd Ste 410
Philadelphia, PA 19114-1029
Phone
(214) 969-4917
Fax
(215) 969-5875
NPI assigned
Dec 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Authorized official

Name
Mr. Wesley O. James
Title
Regional Cfo, Tenet
Phone
(404) 265-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

9501 Roosevelt Blvd Ste 410
Philadelphia, PA 19114-1029

Mailing address

PO Box 822502
Philadelphia, PA 19182-1029
Phone (214) 969-4917

National Provider Directory

National Provider Directory
Tax ID family
St Chris Care at Falls Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9501 Roosevelt Blvd
Ste 410
Philadelphia, PA 19114
Phone (215) 969-4917

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1043379506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 822502",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191821029",
            "telephone_number": "214-969-4917",
            "fax_number": "215-969-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 ROOSEVELT BLVD STE 410",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141029",
            "telephone_number": "214-969-4917",
            "fax_number": "215-969-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST.CHRIS CARE AT NORTHEAST PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "REGIONAL CFO, TENET",
        "authorized_official_telephone_number": "404-265-5009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.