Active NPI
Ivan Denker
- Family Nurse Practitioner
- Philadelphia, PA
National Provider Identifier
1104284835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- SP015880
- Practice address
- 4510 Frankford Ave
Philadelphia, PA 19124-3602 - Phone
- (215) 744-1302
- Fax
- (215) 744-2544
- NPI assigned
- Feb 9, 2016
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN663483 | PA | |
| Registered Nurse | 163W00000X | 26NR17659800 | NJ | |
| Registered Nurse | 163W00000X | 22 710754 | NY | |
| Family Nurse Practitioner | 363LF0000X | SP015880 | PA | Primary |
| Family Nurse Practitioner | 363LF0000X | 33 340355 | NY |
Addresses
Primary practice location
4510 Frankford Ave
Philadelphia, PA 19124-3602
Mailing address
432 N 6TH St
Philadelphia, PA 19123-4004
Phone (215) 925-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NR17659800 | NJ | MD | Registered Nurse |
| 22 710754 | NY | MD | Registered Nurse |
| RN663483 | PA | MD | Registered Nurse |
| 33 340355 | NY | MD | Family Nurse Practitioner |
| SP015880 | PA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mass General Brigham Medical Group Western Massachusetts Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454976000000",
"number": "1104284835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "432 N 6TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191234004",
"telephone_number": "215-925-2400",
"fax_number": "215-925-9162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 FRANKFORD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191243602",
"telephone_number": "215-744-1302",
"fax_number": "215-744-2544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENKER",
"first_name": "IVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-09",
"last_updated": "2016-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN663483",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NJ",
"license": "26NR17659800",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "22 710754",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "PA",
"license": "SP015880",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "33 340355",
"primary": false
}
],
"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 Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.