Individual provider Active NPI

Ioannis Ioannidis, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Philadelphia, PA
National Provider Identifier
1053677807
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD459916 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140
Phone
(215) 707-4353
Fax
(215) 707-2781
NPI assigned
Apr 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD459916 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-4353

Other practice location 1

2451 Fillingim St
Mobile, AL 36617-2238
Phone (251) 471-7786

Other practice location 2

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3209

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
I20180423000090 PA Practitioner - Pathology 1153561584 Reassigns benefits to 1 organization
I20200811001249 NJ Practitioner - Pathology 1153561584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic Pathology Consultants, PAGroup PAC ID 9638144983, 10 clinicians

Practice addresses (Care Compare)

1000 Atlantic Ave
Camden, NJ 08104-1132
Phone (856) 246-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.33 of 100Reported as group
Quality
76.67
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD459916PAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 9, 2019 Accepting new patients
Diagnostic Pathology Consultants PA Anatomic Pathology & Clinical Pathology CurrentSince Jun 1, 2020 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 9, 2019 Accepting new patients

Locations

1919 S Highland Ave
Ste 210A
Lombard, IL 60148

1000 Atlantic Ave
Camden, NJ 08104
Phone (856) 246-3060

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

100 Bowman Dr
Voorhees, NJ 08043
Phone (856) 247-3000

101 Carnie Blvd
Voorhees, NJ 08043
Phone (856) 325-3000

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1053677807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-4353",
            "fax_number": "215-707-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19140",
            "telephone_number": "215-707-4353",
            "fax_number": "215-707-2781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2451 Fillingim St",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366172238",
            "country_code": "US",
            "telephone_number": "251-471-7786",
            "fax_number": "251-471-7884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3400 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044238",
            "country_code": "US",
            "telephone_number": "215-662-3209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IOANNIDIS",
        "first_name": "IOANNIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "PA",
            "license": "MD459916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.