Presbyterian Medical Center of the University of Pennsylvania Health S

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S

Practice address

51 N 39TH St
Philadelphia, PA 19104-2640

Phone

(215) 796-4640

Fax

(215) 762-0754

NPI assigned

Mar 8, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Thomas McCormick V

Title

Avp Finance

Phone

(215) 762-0888

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UPHS Presbyterian Medical Center Doing business as

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Trustees of the University of Pennsylvania

  • Community/Retail Pharmacy
  • Radnor, PA
  • NPI 1922029982

  Member Of

  NPD member

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1073581005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MARKET ST",
            "address_2": "UM600",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022100",
            "telephone_number": "215-796-4640",
            "fax_number": "215-762-0754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-796-4640",
            "fax_number": "215-762-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "AVP FINANCE",
        "authorized_official_telephone_number": "215-762-0888",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "V"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007297070011",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UPHS Presbyterian Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UPHS Presbyterian Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stuart Barry Prenner, MD
• Anna Jenne Prentice, MS
• Mariah Presbery, MD
• Miladis Presbery, IBCLC
• Tina Presbery, LPC, RN, CAADC
• Presbyterian Medical Center of the University of Pennsylvania Health S
• Presbyterian Medical Center of the University of Pennsylvania Health S
• Presbyterian Medical Center of the University of Pennsylvania Health S
• Presbyterian Medical Center of the University of Pennsylvania Health S
• Presbyterian Multi-Specialty Group

• Psychiatric Hospital in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatric Hospital in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.