Individual provider Active NPI

Amandeep Singh Dolla, M.D.

  • Neurocritical Care Physician
  • Philadelphia, PA
National Provider Identifier
1053627679
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
MD452832 Issued in PA
Practice address
909 Walnut St FL 2
Philadelphia, PA 19107-5211
Phone
(215) 955-1234
Fax
(215) 923-6792
NPI assigned
Aug 19, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 6427 NE
Student in an Organized Health Care Education/Training Program 390200000X
Neurocritical Care Physician 2084A2900X MD452832 PA Primary

Addresses

Primary practice location

909 Walnut St FL 2
Philadelphia, PA 19107-5211

Mailing address

909 Walnut St FL 2
Philadelphia, PA 19107-5211
Phone (215) 955-1234

Other practice location 1

900 Walnut St Fl 2
Philadelphia, PA 19107-5509
Phone (215) 955-7000

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
I20170914002120 PA Practitioner - Neurology 2668781998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD452832PAMDNeurocritical Care Physician
6427NEMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Jul 17, 2017 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

909 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

900 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

1101 Chestnut St
Fl 10
Philadelphia, PA 19107
Phone (215) 587-3000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

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 1

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": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1053627679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-1234",
            "fax_number": "215-923-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-1234",
            "fax_number": "215-923-6792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Walnut St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191075509",
            "country_code": "US",
            "telephone_number": "215-955-7000",
            "fax_number": "215-923-3504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLLA",
        "first_name": "AMANDEEP",
        "middle_name": "SINGH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NE",
            "license": "6427",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "PA",
            "license": "MD452832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.