Individual provider Active NPI

Tatiana Berger Policarpo, MD

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1104314947
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD484326 Issued in PA
Practice address
1101 Chestnut St
Philadelphia, PA 19107-3612
Phone
(215) 955-8900
Fax
(215) 923-3447
NPI assigned
Apr 26, 2018
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD484326 PA Primary

Addresses

Primary practice location

1101 Chestnut St
Philadelphia, PA 19107-3612

Mailing address

132 S 10TH Street
480 Main Building
Philadelphia, PA 19107-5244
Phone (215) 955-8900

Other identifiers 1

IdentifierTypeStateIssuer
MD484326OtherPALICENSE

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
I20240514000595 PA Practitioner - GastroenterologyPractitioner - Internal Medicine 5698025724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Boston University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1101 Chestnut St
Philadelphia, PA 19107-3619
Phone (800) 533-3669

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy115
Upper gastrointestinal (GI) endoscopy for acid reflux72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD484326PAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Jun 1, 2024 Accepting new patients
Jefferson University Physicians Gastroenterology Past Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients

Locations

225 E City Line Ave
Ste 109
Bala Cynwyd, PA 19004
Phone (215) 503-3838

1101 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-4226

1101 Chestnut St
#8
Philadelphia, PA 19107
Phone (215) 955-5869

132 S 10th St
#480
Philadelphia, PA 19107
Phone (215) 955-3947

132 S 10th St
Ste 480
Philadelphia, PA 19107
Phone (215) 955-1132

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 3

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": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1104314947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 S 10TH STREET",
            "address_2": "480 MAIN BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075244",
            "telephone_number": "215-955-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073612",
            "telephone_number": "215-955-8900",
            "fax_number": "215-923-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLICARPO",
        "first_name": "TATIANA",
        "middle_name": "BERGER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD484326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD484326",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.