NPIMap

Organization Active NPI

Jefferson Health - Northeast

  • General Acute Care Hospital
  • Philadelphia, PA
National Provider Identifier
1114095791
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
061801 Issued in PA
Legal business name
JEFFERSON HEALTH - NORTHEAST
Practice address
4900 Frankford Ave
Philadelphia, PA 19124-2618
Phone
(215) 831-2000
Fax
(215) 807-8217
NPI assigned
Dec 1, 2006
Last updated
Aug 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Mr. Richard Galup
Title
President
Phone
(215) 612-5038

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 061801 PA Primary

Addresses

Primary practice location

4900 Frankford Ave
Philadelphia, PA 19124-2618

Mailing address

PO Box 781001
Philadelphia, PA 19178-1001
Phone (215) 481-6873

Other names 1

  • Aria Health Frankford Campus Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080412000045 PA Part A Provider - Hospital 5294628236 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockledge, PA; Philadelphia, PA; Horsham, PA; Blue Bell, PA; Bensalem, PA; Abington, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114095791. Details of each certification follow.

Hospital certification: CCN 390115B

Legal name
JEFFERSON HEALTH - NORTHEAST
Organization structure
OtherNon-profit
Incorporated
Aug 5, 1903 in PA
Enrollment address
10800 Knights Road
Philadelphia, PA 19114-4200
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
FHCS Physicians Service8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir.jefferson.edu/FHIRProxy/HOME/api/FHIR/R4

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas Jefferson University Organization, Philadelphia, PA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Mar 31, 2020 100%
Aimee T. James Individual Corporate OfficerAssistant Secretary May 1, 2021
Cristina Cavalieri Individual Corporate OfficerSecretary Jul 1, 2021
Jefferson Health Corporation Organization, Philadelphia, PA Corporation, Holding company, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 30, 2024 100%
Austin Meehan Individual Corporate OfficerVice Chairman Jul 1, 2021
Brian E Sweeney Individual Corporate OfficerPresident Jan 12, 2023
W-2 Managing EmployeePresident Jan 12, 2023
Timothy Maccracken Individual Corporate OfficerAssistant Treasurer Jul 1, 2022
John P Mordach Individual Corporate OfficerTreasurer Jul 1, 2023

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1114095791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781001",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191781001",
            "telephone_number": "215-481-6873",
            "fax_number": "215-481-3985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 FRANKFORD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191242618",
            "telephone_number": "215-831-2000",
            "fax_number": "215-807-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HEALTH - NORTHEAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "GALUP",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-612-5038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "061801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Aria Health Frankford Campus",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Aria Health Frankford Campus",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.