Individual provider Active NPI

Dwight E Stambolian, MD

  • Ophthalmology Physician
  • Philadelphia, PA
National Provider Identifier
1093807489
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD023242E Issued in PA
Practice address
51 N 39TH St
Philadelphia, PA 19104-2640
Phone
(215) 662-2286
Fax
(215) 615-0500
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD023242E PA Primary

Addresses

Primary practice location

51 N 39TH St
Philadelphia, PA 19104-2640

Mailing address

51 N 39TH St
Philadelphia, PA 19104-2614
Phone (215) 662-2286

Other identifiers 1

IdentifierTypeStateIssuer
0011665770001MedicaidPA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100316000301 PA Practitioner - Ophthalmology 1557496510 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, shared by 15 NPIs, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Philadelphia, PA 19104-5127
Phone (215) 614-4100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group Ophthalmology CurrentSince May 1, 2015 Accepting new patients
University of Penn - Medical Group CurrentSince Sep 8, 2010 Accepting new patients
University of Penn-Medical Group CurrentSince Sep 8, 2010 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

3615 Chestnut St
Ste 141
Philadelphia, PA 19104
Phone (215) 662-2600

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

3400 Civic Center Blvd
#3W
Philadelphia, PA 19104
Phone (215) 615-0063

3400 Civic Center Blvd
#3R
Philadelphia, PA 19104
Phone (215) 349-9093

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

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1093807489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042614",
            "telephone_number": "215-662-2286",
            "fax_number": "215-615-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-2286",
            "fax_number": "215-615-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAMBOLIAN",
        "first_name": "DWIGHT",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD023242E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011665770001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.