Individual provider Active NPI

Christine A Deforest, D.O.

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1104052794
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25MB12688800 Issued in NJ
Practice address
51 N 39TH St
M01 Myrin Basement
Philadelphia, PA 19104
Phone
(267) 588-6915
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS023866 PA
Emergency Medicine Physician 207P00000X 25MB12688800 NJ Primary

Addresses

Primary practice location

51 N 39TH St
M01 Myrin Basement
Philadelphia, PA 19104

Mailing address

3001 N Green Bay Rd
North Chicago, IL 60064
Phone (412) 973-3102

Other practice location 1

3001 N Green Bay Rd
North Chicago, IL 60064
Phone (267) 588-6915

Other identifiers 1

IdentifierTypeStateIssuer
VAD0000OtherEMERGENCY MEDICINE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, PA, NJ3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20180406001106 NC Practitioner - Emergency Medicine 7315200268
I20240930000345 PA Practitioner - Emergency Medicine 7315200268 Reassigns benefits to 1 organization
I20250627001547 NJ Practitioner - Emergency Medicine 7315200268 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Philadelphia Col of Osteo Med, Sewanee, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Physician Associates of South Jersey P CGroup PAC ID 5294648457, 94 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

100 Bowman Dr
Voorhees, NJ 08043-9619
Phone (856) 247-3000

51 N 39TH St
Philadelphia, PA 19104-2640
Phone (215) 662-8214

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB12688800NJMDEmergency Medicine Physician
OS023866PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Mar 1, 2018 Accepting new patients
Emergency Physician Associates of South Jersey P C Emergency Medicine CurrentSince Aug 10, 2025 Accepting new patients
University of Penn-Medical Group CurrentSince Sep 1, 2024 Accepting new patients
Emergency Physician Services of New Jersey,Professional Association Emergency Medicine CurrentSince Aug 10, 2025 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Sep 1, 2024 Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

100 Townsend Ave
Berlin, NJ 08009
Phone (856) 322-3000

200 Trenton Rd
Browns Mills, NJ 08015
Phone (609) 893-1200

90 Brick Rd
Marlton, NJ 08053
Phone (856) 355-6040

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

100 Bowman Dr
Voorhees, NJ 08043
Phone (856) 247-3000

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

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1104052794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 N GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "60064",
            "telephone_number": "412-973-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "address_2": "M01 MYRIN BASEMENT",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "267-588-6915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 N Green Bay Rd",
            "address_purpose": "LOCATION",
            "city": "North Chicago",
            "state": "IL",
            "postal_code": "60064",
            "country_code": "US",
            "telephone_number": "267-588-6915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEFOREST",
        "first_name": "CHRISTINE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS023866",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB12688800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMERGENCY MEDICINE",
            "identifier": "VAD0000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.