NPIMap

Individual provider Active NPI

John M Bruza, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1093758310
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD064174L Issued in PA
Practice address
3615 Chestnut Street
Ralston - Penn Center
Philadelphia, PA 19104-2612
Phone
(215) 662-2746
Fax
(215) 349-5648
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD064174L PA Primary

Addresses

Primary practice location

3615 Chestnut Street
Ralston - Penn Center
Philadelphia, PA 19104-2612

Mailing address

3615 Chestnut Street
Ralston - Penn Center
Philadelphia, PA 19104-2612
Phone (215) 662-2746

Other identifiers 1

IdentifierTypeStateIssuer
0016745200001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100412000021 PA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5991831430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
University of Oklahoma College of Medicine, 1991
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)

145 King of Prussia Rd
Suite 205
Radnor, PA 19087-4557
Phone (610) 902-4859

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jan 21, 1998 Accepting new patients
University of Penn - Medical Group Internal Medicine CurrentSince Jan 21, 1998 Accepting new patients
University of Penn - Medical Group Past Accepting new patients
Presbyterian Medical Center of the University of Pennsylvania Health S Past Accepting new patients

Locations

3615 Chestnut St
Philadelphia, PA 19104
Phone (215) 662-2746

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

145 King of Prussia Rd
Ste 205
Wayne, PA 19087
Phone (610) 902-4858

Organizations & group practices 4

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 8

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1093758310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT STREET",
            "address_2": "RALSTON - PENN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612",
            "telephone_number": "215-662-2746",
            "fax_number": "215-349-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT STREET",
            "address_2": "RALSTON - PENN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612",
            "telephone_number": "215-662-2746",
            "fax_number": "215-349-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUZA",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD064174L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016745200001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.