NPIMap

Individual provider Active NPI

Jarrod D. Predina, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Philadelphia, PA
National Provider Identifier
1073873022
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
MD456124 Issued in PA
Practice address
3400 Civic Center Blvd
West Pavilion 1St FLR
Philadelphia, PA 19104-4306
Phone
(215) 615-5864
Fax
(215) 349-8432
NPI assigned
May 24, 2012
Last updated
Apr 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD456124 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
West Pavilion 1St FLR
Philadelphia, PA 19104-4306

Mailing address

3400 Civic Center Blvd
West Pavilion 1St FLR
Philadelphia, PA 19104-4306
Phone (215) 615-5864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151116000248 PA Practitioner - Thoracic SurgeryPractitioner - General Surgery 1153575212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Pennsylvania State University College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Philadelphia, PA 19104-5127
Phone (215) 615-5864

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32210MNMDClinical Social Worker
MD456124PAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
University of Penn - Medical Group CurrentSince Jan 1, 2023 Accepting new patients
University of Penn-Medical Group CurrentSince Jan 1, 2023 Accepting new patients
University of Penn - Medical Group Past Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Fl 2
Berwyn, PA 19312
Phone (610) 576-7500

3400 Civic Center Blvd
Fl 1
Philadelphia, PA 19104
Phone (215) 615-5864

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

Organizations & group practices 5

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 3

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": "1337817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1073873022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "WEST PAVILION 1ST FLR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044306",
            "telephone_number": "215-615-5864",
            "fax_number": "215-349-8432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "WEST PAVILION 1ST FLR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044306",
            "telephone_number": "215-615-5864",
            "fax_number": "215-349-8432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREDINA",
        "first_name": "JARROD",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-24",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD456124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.