Nazareth Hospital
Organization Active NPI General Acute Care Hospital · Philadelphia, PA
NPI 1124023015 · NPPES record last updated Jun 2, 2025
Key facts
- NPI
- 1124023015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 400301 (PA)
- Legal business name
- NAZARETH HOSPITAL
- Practice address
- 2601 Holme Ave
Philadelphia, PA 19152-2007 - Phone
- (215) 335-6000
- Fax
- (215) 335-6303
- NPI assigned
- Jun 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. David A. Wajda
- Title
- Chief Financial Officer, VP Finance
- Phone
- (215) 335-6043
Owners & managing parties with NPI records 2
-
Hiral P. Fontanilla, M.D.
-
James Monihan, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 7
Facilities with the same owner 158
Practitioners 59
-
Yana Ananeva, NP
-
Charmaine San Yee Chan, D.O.
-
Erica B Polaneczky, APNC
-
Kareem Abed, MD, MBA
-
Violetta Berdichevskaya, M.D.
-
Sunil Kumar Dhar, MD
-
Hanh Nhon Doan, MD
-
Umme Farwa, MD
-
Ramprasad Gadi, MD
-
Daniel Marc Goldman, M.D.
-
Ralph Gonzalez Jr., M.D.
-
Jamaal Hardee, MD
-
Phillip Liu, DO
-
Jayamohan Nair, MD
-
Omer Salah Nasir, M.D.
-
Andrew R. Ogden, D.O.
-
Krishna Patel, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Hospital certification: CCN 390204A
- Legal name
- NAZARETH HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 15, 1994 in PA
- Enrollment address
- 2601 Holme Avenue
Philadelphia, PA 19152-2007 - Hospital subgroups
- Acute care, Rehabilitation
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Marianne Grace |
Corporate Director |
Jan 1, 2022 | |
| Geraldine Hoyler |
Corporate Director |
Jan 1, 2026 | |
| James M Monihan |
Corporate Director |
Jan 1, 2020 | |
| Julie Keese |
Corporate Officer |
Jun 21, 2025 | |
| W-2 Managing Employee |
Jun 21, 2025 | ||
| Sandra Lynn Kweder |
Corporate Director |
Jan 1, 2025 | |
| Jacqueline a Watson |
Corporate Director |
Jan 1, 2025 | |
| Julie Washington |
Corporate Director |
Jul 1, 2020 | |
| Ajay K Gupta |
Corporate Officer |
Jan 1, 2025 | |
| Corporate Director |
Jan 1, 2025 | ||
| Barbara Buckley |
Corporate Director |
Jan 1, 2022 | |
| Leena Alex |
Corporate Officer |
Jan 6, 2025 | |
| Larry Warren |
Corporate Director |
Jan 1, 2025 | |
| Robin W Madden |
Corporate Director |
Jan 1, 2025 | |
| Laura Williams |
Corporate Officer |
Jan 1, 2025 | |
| W-2 Managing Employee |
Jan 1, 2025 | ||
| Andre Boyd |
Corporate Officer |
Jan 6, 2025 | |
| Corporate Director |
Jan 6, 2025 | ||
| Hiral P Fontanilla |
Corporate Director |
Jan 1, 2022 | |
| Michelle Calope |
Corporate Director |
Jan 1, 2023 | |
| Michael a Magro |
Corporate Officer |
Jun 24, 2021 | |
| Shaila Kapur |
Corporate Director |
Jul 1, 2019 | |
| Trinity Health Corporation |
5% Or Greater Indirect Ownership Interest | Apr 3, 2020 | 100% |
| Carmen O Larsen |
Corporate Director |
Jan 1, 2025 | |
| Trinity Health of the Mid-Atlantic Region |
5% Or Greater Direct Ownership Interest | Apr 3, 2020 | 100% |
| Vincent D Gordon |
Corporate Officer |
Jan 1, 2025 | |
| Corporate Director |
Jul 1, 2019 | ||
| Catherine Mikus |
Corporate Officer |
Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040114000367 | PA | Part B Supplier - Clinic/Group Practice | 1951202910 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment Practice locations: Philadelphia, PA |
| O20080221000520 | PA | Part a Provider - Hospital | 1951202910 |
1 other NPI on this enrollment Practice locations: Philadelphia, PA |
National Provider Directory
- Tax ID family
- Nazareth Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 400301 | PA | Yes |
Addresses
Primary practice location
2601 Holme Ave
Philadelphia, PA 19152-2007
Mailing address
2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (215) 335-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P030272 | Other | PA | CHAMPUS |
| 1007654720011 | Medicaid | PA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Philadelphia, PA
- Kyle Naylor
- Sosheel Nayyer
- Daniel Nazaire Sr.
- Nazareth Cardiology, PC
- Nazareth Hospital
- Nazareth Hospital
- Nazareth Hospital
- Nazareth Hospital
- Nazareth Hospital
- Nazareth Imaging Associates
All providers in Philadelphia, PA · General Acute Care Hospital in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.