Active NPI
Trustees of the University of Pennsylvania
- Internal Medicine Physician
- Radnor, PA
National Provider Identifier
1083720403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
- Practice address
- 250 King of Prussia Rd
Radnor, PA 19087-5220 - Phone
- (610) 902-2000
- NPI assigned
- Aug 21, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth Johnston
- Title
- Executive Director
- Phone
- (215) 662-7583
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PA | ||
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | PA | ||
| Internal Medicine Physician | 207R00000X | Primary | ||
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | PA |
Addresses
Primary practice location
250 King of Prussia Rd
Radnor, PA 19087-5220
Mailing address
3624 Market St
Suite 560W
Philadelphia, PA 19104-2614
Phone (215) 662-2286
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 732227 | Other | PA | AETNA |
| CN3127 | Other | PA | RR MEDICARE |
| 096188 | Other | PA | BLUE SHIELD |
| 18041 | Other | PA | HEALTHPARTERNS |
| 1001258770 | Medicaid | PA | |
| 1041746 | Other | PA | MERCY |
| 2Y21509 | Other | PA | HEALTHNET |
| 8696501 | Medicaid | NJ | |
| 0143087001 | Other | PA | KEYSTONE |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1212451200000",
"number": "1083720403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3624 MARKET ST",
"address_2": "SUITE 560W",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042614",
"telephone_number": "215-662-2286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 KING OF PRUSSIA RD",
"city": "RADNOR",
"state": "PA",
"postal_code": "190875220",
"telephone_number": "610-902-2000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-21",
"last_updated": "2008-06-03",
"status": "A",
"authorized_official_last_name": "JOHNSTON",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "215-662-7583"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "PA",
"license": null,
"primary": false
},
{
"code": "207QG0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine, Geriatric Medicine",
"state": "PA",
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207RG0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "PA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "732227",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CN3127",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "096188",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTERNS",
"identifier": "18041",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1001258770",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "1041746",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "2Y21509",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8696501",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE",
"identifier": "0143087001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Radnor, PA
- Trustees of the Univ of PA
- Trustees of the Univ of PA
- Trustees of the Univ of PA
- Trustees of the Univ of PA
- Trustees of the University of Pennsylvania
- Trustees of the University of Pennsylvania
- Trustees of the University of Pennsylvania
- Trustees of the University of Pennsylvania
- Trustees of the University of Pennsylvania
- Trustees of the University of Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.