Individual provider Active NPI

Erin Elizabeth Tully, MD

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1053949768
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD484578 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 662-4000
NPI assigned
Mar 29, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PA
Pediatrics Physician 208000000X MD484578 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

2929 Arch Street
Cira Center 12TH FL
Philadelphia, PA 19104-2857
Phone (717) 712-3841

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
I20240515000061 PA Practitioner - Internal Medicine 1850783358 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD484578PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Jun 23, 2024 Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Jul 1, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Jun 23, 2024 Accepting new patients
Trustees of the University of Pennsylvania CurrentSince Jun 24, 2024 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childen'S Health Care Associates Inc. CurrentSince Jul 1, 2024 Accepting new patients
Presbyterian Medical Center of the University of Pennsylvania Health S Past Accepting new patients

Locations

3701 Market St
Ste 640
Philadelphia, PA 19104
Phone (215) 662-2250

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3701 Market St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-2250

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1053949768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 ARCH STREET",
            "address_2": "CIRA CENTER 12TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042857",
            "telephone_number": "717-712-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY",
        "first_name": "ERIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-29",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD484578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.