Individual provider Active NPI

Jennifer Villasenor-Park, MD

  • Dermatology Physician
  • Philadelphia, PA
National Provider Identifier
1053547851
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD450451 Issued in PA
Practice address
3400 Civic Center Blvd
1-330S Perelman Center
Philadelphia, PA 19104-5127
Phone
(215) 662-2737
Fax
(215) 615-3424
NPI assigned
Jun 8, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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 MD450451 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
1-330S Perelman Center
Philadelphia, PA 19104-5127

Mailing address

1000 Floral Vale Blvd
Ste 100
Yardley, PA 19067-5579
Phone (215) 662-2737

Other practice location 1

3400 Spruce St
2 Maloney
Philadelphia, PA 19104-4238
Phone (215) 662-2737

Other names 1

  • Jennifer Villasenor Former name

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
I20140807000155 PA Practitioner - Dermatology 5799902219 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Harvard Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Philadelphia, PA 19104-5127

3400 Civic Ctr Blvd 1
Abram Cancer Ctr Pacam 1 FLR
Philadelphia, PA 19104-5127
Phone (215) 893-2600

3400 Civic Ctr Blvd 3Rd Floor Sout
Penn Medicine Otorhinolaryngology Head and N
Philadelphia, PA 19104-5127
Phone (215) 662-2777

3400 Civic Ctr Blvd 4TH
Philadelphia, PA 19104-5127
Phone (215) 662-2626

3400 Civic Ctr Blvd 4TH Floor
Advanced Wound Healing and Lower Extremity Re
Philadelphia, PA 19104-5127
Phone (215) 662-7300

3400 Civic Ctr Blvd 4TH Floor Per
Gi Surgery Pcam
Philadelphia, PA 19104-5127
Phone (215) 662-2626

3400 Civic Ctr Blvd 4TH Floor S
Oral/Maxill Surgery Pcam
Philadelphia, PA 19104-5127
Phone (215) 662-3580

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

800 Spruce St
Philadelphia, PA 19107-6130

800 Spruce St Cathcart Building
Penn Radiology Mobile Mammography Pennsylva
Philadelphia, PA 19107-6130
Phone (215) 829-3282

Hospital & facility affiliations

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) excision105
Removal of skin lesions691
Removal of skin cancer1-10
Removal or shaving of skin growth29
Skin biopsy675

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD450451PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Dermatology CurrentSince May 1, 2015 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Dec 16, 2025 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. Dermatology CurrentSince Dec 16, 2025 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

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

800 Spruce St
Fl 10
Philadelphia, PA 19107
Phone 2157327600102

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

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

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

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

7133 Roosevelt Blvd
Philadelphia, PA 19149
Phone (215) 333-3311

1000 Floral Vale Blvd
Ste 100
Yardley, PA 19067
Phone (215) 752-4020

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

Organizations & group practices 8

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 5

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": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1053547851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 FLORAL VALE BLVD",
            "address_2": "STE 100",
            "city": "YARDLEY",
            "state": "PA",
            "postal_code": "190675579",
            "telephone_number": "215-662-2737",
            "fax_number": "215-615-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1-330S PERELMAN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2737",
            "fax_number": "215-615-3424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce St",
            "address_2": "2 Maloney",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044238",
            "country_code": "US",
            "telephone_number": "215-662-2737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLASENOR-PARK",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-08",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD450451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "VILLASENOR",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.