Active NPI
Alec Pupo
- Student in an Organized Health Care Education/Training Program
- Philadelphia, PA
National Provider Identifier
1063215796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4170 City Ave
Philadelphia, PA 19131-1610 - Phone
- (215) 871-6100
- NPI assigned
- Mar 28, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4170 City Ave
Philadelphia, PA 19131-1610
Mailing address
411 Berry LN
Media, PA 19063-1160
Phone (610) 585-9179
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250815004499 | PA | Order and Referring Only - Internal Medicine | 8820597974 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743120000000",
"number": "1063215796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 BERRY LN",
"city": "MEDIA",
"state": "PA",
"postal_code": "190631160",
"telephone_number": "610-585-9179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4170 CITY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311610",
"telephone_number": "215-871-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUPO",
"first_name": "ALEC",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2025-03-28",
"last_updated": "2025-03-28",
"certification_date": "2025-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.