Temple University of the Commonwealth System of Higher Education

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Doing business as

Temple Pain Management

Practice address

3401 N Broad St
3Rd Floor, Out Patient BLDG
Philadelphia, PA 19140-5103

Phone

(215) 707-1407

Fax

(215) 707-8028

NPI assigned

Oct 12, 2005

Organization subpart

No

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

Authorized official

Name

Tonya Woodard

Title

Credentialing/Management

Phone

(215) 707-3911

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Temple Pain Management Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Margaret Ann Malloy, PA-C

  • Physician Assistant
  • Philadelphia, PA
  • NPI 1780283986
  NPD (past)
• Emily Shissler, PA-C

  • Physician Assistant
  • Philadelphia, PA
  • NPI 1205437704
  NPD (past)
• Ramin Ansari

  • Neurology Physician
  • Frisco, TX
  • NPI 1801048285
  NPD (past)
• Jennifer Lynn Burdo, PA-C

  • Physician Assistant
  • Toms River, NJ
  • NPI 1285046177
  NPD (past)
• Jeremy Huttner

  • General Practice Dentistry
  • Clackamas, OR
  • NPI 1134476674
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1083602106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-1407",
            "fax_number": "215-707-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "address_2": "3RD FLOOR, OUT PATIENT BLDG",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-1407",
            "fax_number": "215-707-8028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112442",
            "country_code": "US",
            "telephone_number": "215-707-1407",
            "fax_number": "215-707-8298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGEMENT",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130673",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130827",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education (Temple Rad Oncology Assoc)
• Temple University of the Commonwealth System of Higher Education (Temple Neurology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Maternal Fetal Medicine)
• Temple University of the Commonwealth System of Higher Education (Temple Ambulatory Care Surgical Center-Anesthesiology)
• Temple University of the Commonwealth System of Higher Education (Temple Orthopedics & Sports Medicine)
• Temple University of the Commonwealth System of Higher Education (Temple Gastroenterology)
• Temple University of the Commonwealth System of Higher Education (Temple Cardiology)
• Temple University of the Commonwealth System of Higher Education (Temple Neurosurgical)
• Temple University of the Commonwealth System of Higher Education (Ophthalmology Associates PPP)
• Temple University of the Commonwealth System of Higher Education (Temple Critical Care Peds Tucmc)

• Pain Medicine (Anesthesiology) Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pain Medicine (Anesthesiology) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.