Individual provider Active NPI

Kathleen Grogan, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1093388423
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA062784 Issued in PA
Practice address
3400 Spruce Street
4TH Floor Silverstein
Philadelphia, PA 19104-4206
Phone
(215) 662-2078
Fax
(215) 615-0471
NPI assigned
Jul 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA062784 PA Primary

Addresses

Primary practice location

3400 Spruce Street
4TH Floor Silverstein
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce Street
4TH Floor Silverstein
Philadelphia, PA 19104-4206
Phone (215) 662-2078

Other practice location 1

503 N 21st St
Camp Hill, PA 17011-2204
Phone (717) 763-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211021001789 PA Practitioner - Physician Assistant 7214325380 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Health Physician Services - Trauma CurrentSince Oct 1, 2023 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 28, 2023 Accepting new patients
Aria Health Physician Services CurrentSince Oct 1, 2023 Accepting new patients

Locations

3998 Red Lion Rd
Philadelphia, PA 19114
Phone (215) 612-4060

3400 Spruce St
Fl 4
Philadelphia, PA 19104
Phone (215) 662-2050

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1093388423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "4TH FLOOR SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-2078",
            "fax_number": "215-615-0471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "4TH FLOOR SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-2078",
            "fax_number": "215-615-0471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "503 N 21st St",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170112204",
            "country_code": "US",
            "telephone_number": "717-763-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROGAN",
        "first_name": "KATHLEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-22",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.