Active NPI
Martin Reivich, MD
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1083940464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD005708E
- Practice address
- 3450 Hamilton Walk
415 Stemmler Hall
Philadelphia, PA 19104-6118 - Phone
- (215) 662-2632
- Fax
- (215) 349-5629
- NPI assigned
- Oct 20, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD005708E | PA | Primary |
Addresses
Primary practice location
3450 Hamilton Walk
415 Stemmler Hall
Philadelphia, PA 19104-6118
Mailing address
3450 Hamilton Walk
415 Stemmler Hall
Philadelphia, PA 19104-6118
Phone (215) 662-2632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334620800000",
"number": "1083940464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 HAMILTON WALK",
"address_2": "415 STEMMLER HALL",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191046118",
"telephone_number": "215-662-2632",
"fax_number": "215-349-5629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 HAMILTON WALK",
"address_2": "415 STEMMLER HALL",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191046118",
"telephone_number": "215-662-2632",
"fax_number": "215-349-5629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REIVICH",
"first_name": "MARTIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-20",
"last_updated": "2012-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD005708E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.