NPIMap

Individual provider Active NPI

Violetta Berdichevskaya, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1104882646
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD418392 Issued in PA
Practice address
2701 Holme Ave
Suite 201
Philadelphia, PA 19152-2029
Phone
(215) 350-7417
Fax
(215) 335-6303
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

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 MD418392 PA Primary

Addresses

Primary practice location

2701 Holme Ave
Suite 201
Philadelphia, PA 19152-2029

Mailing address

1 W Elm St
Suite 100
Conshohocken, PA 19428-2007
Phone (610) 567-6967

Other identifiers 11

IdentifierTypeStateIssuer
1194654OtherPAAETNA USH HMO
1442044OtherPAPA BLUE SHIELD #
2125868000OtherPAIBC #
9254256OtherPACIGNA
HIGHMARK BLUE SHIELDOther1442044
9973OtherPABRAVO ELDERHEALTH
37809MD418392OtherPAHEALTHPARTNERS
30043419OtherPAKMHP WOODWARD
0019378550002MedicaidPA
30029002OtherPAKMHP
7546410OtherPAAETNA USH PPO

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
I20040115000040 PA Practitioner - Internal Medicine 3476454398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avellina Inc.Group PAC ID 4385715788, 3 clinicians

Practice addresses (Care Compare)

2375 Woodward St
Suite 112N
Philadelphia, PA 19115-5105
Phone (215) 676-9223

2701 Southampton Rd
Philadelphia, PA 19154-1205
Phone (215) 856-2714

Hospital & facility affiliations

  • Aurora Hospice, Inc. Hospice, Feasterville, PA, CCN 391738
  • Nazareth Hospital Hospital, Philadelphia, PA, CCN 390204
  • Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142
  • Holy Redeemer Hospital and Medical Center Hospital, Meadowbrook, PA, CCN 390097
  • Silver Stream Rehabilitation and Nursing Center Nursing home, Spring House, PA, CCN 395354
  • Roosevelt Rehabilitation and Healthcare Center Nursing home, Philadelphia, PA, CCN 395537
  • Oakwood Healthcare & Rehabilitation Center Nursing home, Philadelphia, PA, CCN 395110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD418392PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avellina Inc. Internal Medicine CurrentSince Apr 1, 2008 Accepting new patients
Nazareth Hospital Past Accepting new patients
Mayfair Operator LLC Past Accepting new patients
Silver Stream Nursing and Rehab Facility LLC Past Accepting new patients

Locations

2601 Holme Ave
Philadelphia, PA 19152
Phone (215) 335-6000

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 6

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1104882646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W ELM ST",
            "address_2": "SUITE 100",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282007",
            "telephone_number": "610-567-6967",
            "fax_number": "610-567-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 HOLME AVE",
            "address_2": "SUITE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522029",
            "telephone_number": "215-350-7417",
            "fax_number": "215-335-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERDICHEVSKAYA",
        "first_name": "VIOLETTA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD418392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USH HMO",
            "identifier": "1194654",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD #",
            "identifier": "1442044",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC #",
            "identifier": "2125868000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9254256",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1442044",
            "identifier": "HIGHMARK BLUE SHIELD",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRAVO ELDERHEALTH",
            "identifier": "9973",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "37809MD418392",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KMHP WOODWARD",
            "identifier": "30043419",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019378550002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KMHP",
            "identifier": "30029002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USH PPO",
            "identifier": "7546410",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.