NPIMap

Organization Active NPI

Davita Medical Group Philadelphia, LLC

  • Internal Medicine Physician
  • Malvern, PA
National Provider Identifier
1083157150
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DAVITA MEDICAL GROUP PHILADELPHIA, LLC
Practice address
2476 Swedesford Rd
#150
Malvern, PA 19355-1456
Phone
(844) 902-2345
NPI assigned
Nov 22, 2016
Last updated
May 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Michael J Lipp
Title
Shareholder
Phone
(844) 902-2345

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU

Addresses

Primary practice location

2476 Swedesford Rd
#150
Malvern, PA 19355-1456

Mailing address

2476 Swedesford Rd
#150
Malvern, PA 19355-1456
Phone (844) 902-2345

National Provider Directory

National Provider Directory
Tax ID family
Davita Medical Group Philadelphia LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1083157150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2476 SWEDESFORD RD",
            "address_2": "#150",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551456",
            "telephone_number": "844-902-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2476 SWEDESFORD RD",
            "address_2": "#150",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551456",
            "telephone_number": "844-902-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVITA MEDICAL GROUP PHILADELPHIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "LIPP",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "844-902-2345"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malvern, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.