Individual provider Active NPI

Jeremy David Close, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Philadelphia, PA
National Provider Identifier
1114049566
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD435873 Issued in PA
Practice address
925 Chestnut St
5TH Floor
Philadelphia, PA 19107-4216
Phone
(267) 339-3500
Fax
(267) 339-3761
NPI assigned
Apr 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT188739 PA
Family Medicine Physician 207Q00000X MD435873 PA
Sports Medicine (Family Medicine) Physician 207QS0010X MD435873 PA Primary

Addresses

Primary practice location

925 Chestnut St
5TH Floor
Philadelphia, PA 19107-4216

Mailing address

833 Chestnut Street
Suite 1402
Philadelphia, PA 19107-4405
Phone (267) 339-7839

Other identifiers 1

IdentifierTypeStateIssuer
102521117MedicaidPA

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
I20101129000079 PA Practitioner - Sports MedicinePractitioner - Family Practice 5597951822 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Methodist Associates in Healthcare, IncGroup PAC ID 6406755651, 387 clinicians
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, shared by 15 NPIs, 493 clinicians
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

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

201 2ND Ave
Collegeville, PA 19426-3613
Phone (610) 489-7703

2301 S Broad St
Philadelphia, PA 19148-3542

833 Chestnut St
East 3Rd FLR Suite 301SP
Philadelphia, PA 19107-5102
Phone (215) 955-7190

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Good Shepherd Penn Partners Long-term care hospital, Philadelphia, PA, CCN 392050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT188739PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Family Medicine CurrentSince Jul 28, 2010 Accepting new patients
Methodist Associates in Healthcare, Inc Family Medicine CurrentSince Oct 1, 2021 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Oct 1, 2021 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

170 S Independence Mall W
Ste L50
Philadelphia, PA 19106

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

925 Chestnut St
Fl 5
Philadelphia, PA 19107
Phone (267) 339-3738

833 Chestnut St
Frnt 3
Philadelphia, PA 19107
Phone (215) 955-5800

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

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

833 Chestnut St
Ste 301
Philadelphia, PA 19107
Phone (215) 955-2363

Organizations & group practices 4

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 4

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": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434931200000",
    "number": "1114049566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT STREET",
            "address_2": "SUITE 1402",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074405",
            "telephone_number": "267-339-7839",
            "fax_number": "267-339-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST",
            "address_2": "5TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "267-339-3500",
            "fax_number": "267-339-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOSE",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-05",
        "last_updated": "2015-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT188739",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD435873",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "MD435873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102521117",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.