NPIMap

Organization Active NPI

Pennsport Internal Medicine Group, PC

  • Internal Medicine Physician
  • Phila, PA
National Provider Identifier
1114100336
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS003325L Issued in PA
Legal business name
PENNSPORT INTERNAL MEDICINE GROUP, PC
Practice address
1817 S 2ND St
Phila, PA 19148-1945
Phone
(215) 389-3368
Fax
(215) 389-1225
NPI assigned
Dec 11, 2007
Last updated
Apr 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Authorized official

Name
Dr. Kenneth Winokur, DONPI 1295814598
Title
President
Phone
(215) 389-6120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X OS003325L PA Primary

Addresses

Primary practice location

1817 S 2ND St
Phila, PA 19148-1945

Mailing address

1817 S 2ND St
Phila, PA 19148-1945
Phone (215) 389-3368

National Provider Directory

National Provider Directory

Locations

1817 S 2nd St
Philadelphia, PA 19148
Phone (215) 389-6120

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1114100336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 S 2ND ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191481945",
            "telephone_number": "215-389-3368",
            "fax_number": "215-389-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 S 2ND ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191481945",
            "telephone_number": "215-389-3368",
            "fax_number": "215-389-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSPORT INTERNAL MEDICINE GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "WINOKUR",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-389-6120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS003325L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.

Verify at the official NPI Registry.