Individual provider Active NPI

Jae Won Song, M.D.

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1053573766
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD464345 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104
Phone
(215) 662-3000
NPI assigned
Jun 25, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD464345 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180731000507 PA Practitioner - Diagnostic Radiology 2769773787 Reassigns benefits to 1 organization
I20180829003389 NJ Practitioner - Diagnostic Radiology 2769773787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinical Health Care Associates of New Jersey PCGroup PAC ID 0749180198, shared by 7 NPIs, 793 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1006 Mantua Pike
Woodbury, NJ 08097-1221
Phone (856) 686-8282

1865 Route 70 E 130
Rad Cherry Hill
Cherry Hill, NJ 08003-2013
Phone (856) 433-2535

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jul 16, 2018 Accepting new patients
University of Penn-Medical Group Diagnostic Radiology CurrentSince Jul 16, 2018 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Clinical Health Care Associates of New Jersey, PC Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 16, 2018 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jul 18, 2018 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. Diagnostic Radiology CurrentSince Jul 16, 2018 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

1601 Haddon Ave
Camden, NJ 08103
Phone (856) 757-3700

1865 Route 70 E
Ste 130
Cherry Hill, NJ 08003
Phone (856) 433-2535

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

1006 Mantua Pike
Woodbury Hts, NJ 08097
Phone (856) 845-6880

1001 Chesterbrook Blvd
Ste 100
Berwyn, PA 19312
Phone (610) 576-7500

402 McFarlan Rd
Ste 201
Kennett Square, PA 19348
Phone (610) 444-2665

491 Allendale Rd
Ste 104
Kng of Prussa, PA 19406
Phone (215) 860-3360

11 Friends Ln
Ste 101
Newtown, PA 18940
Phone (215) 579-1300

250 W Lancaster Ave
Ste 180
Paoli, PA 19301
Phone (610) 644-0477

3737 Market St
Fl 7
Philadelphia, PA 19104

1840 South St
Ste 3
Philadelphia, PA 19146
Phone (215) 546-1893

235 S 33rd St
Philadelphia, PA 19104
Phone (215) 615-4400

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

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

3737 Market St
Fl 8
Philadelphia, PA 19104
Phone (215) 662-4333

3400 Spruce St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-3005

140 Nutt Rd
Phoenixville, PA 19460
Phone (610) 983-1000

145 King of Prussia Rd
Ste 111
Radnor, PA 19087
Phone (610) 902-1800

420 W Linfield Trappe Rd
Bldg A
Royersford, PA 19468

915 Old Fern Hill Rd
Ste D400
West Chester, PA 19380

701 E Marshall St
West Chester, PA 19380
Phone (610) 431-5000

455 Woodview Rd
West Grove, PA 19390
Phone (610) 345-1960

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

777 Township Line Rd
Ste 150
Yardley, PA 19067
Phone (215) 860-3360

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": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1053573766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JAE",
        "middle_name": "WON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-25",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD464345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.