NPIMap

Organization Active NPI

Nazareth Hospital

  • General Acute Care Hospital
  • Philadelphia, PA
National Provider Identifier
1124023015
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
400301 Issued in 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
Last updated
Jun 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Authorized official

Name
Mr. David A. Wajda
Title
Chief Financial Officer, VP Finance
Phone
(215) 335-6043

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 400301 PA Primary

Addresses

Primary practice location

2601 Holme Ave
Philadelphia, PA 19152-2007

Mailing address

2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (215) 335-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124023015. Details of each certification follow.

Hospital certification: CCN 390204A

Legal name
NAZARETH HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Nov 15, 1994 in PA
Enrollment address
2601 Holme Avenue
Philadelphia, PA 19152-2007
Main/Primary Hospital Location
Hospital subgroups
Acute care, Rehabilitation

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Nazareth Hosp8 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.

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Marianne Grace Individual Corporate DirectorBoard Member Jan 1, 2022
Geraldine Hoyler Individual Corporate DirectorBoard Member Jan 1, 2026
James M Monihan Individual Corporate DirectorBoard Member Jan 1, 2020
Julie Keese Individual Corporate OfficerTreasurer and VP, Finance and CF Jun 21, 2025
W-2 Managing EmployeeVP, Finance and Cfo Jun 21, 2025
Sandra Lynn Kweder Individual Corporate DirectorBoard Member Jan 1, 2025
Jacqueline a Watson Individual Corporate DirectorBoard Member Jan 1, 2025
Julie Washington Individual Corporate DirectorBoard Member Jul 1, 2020
Ajay K Gupta Individual Corporate OfficerVice-Chair Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2025
Barbara Buckley Individual Corporate DirectorBoard Member Jan 1, 2022
Leena Alex Individual Corporate OfficerDirector Finance Operations Jan 6, 2025
Larry Warren Individual Corporate DirectorBoard Member Jan 1, 2025
Robin W Madden Individual Corporate DirectorBoard Member Jan 1, 2025
Laura Williams Individual Corporate OfficerRegional Manager of Medical Group Jan 1, 2025
W-2 Managing EmployeeRegional Manager of Medical Group Jan 1, 2025
Andre Boyd Individual Corporate OfficerPresident and Ceo Jan 6, 2025
Corporate DirectorBoard Member Jan 6, 2025
Hiral P Fontanilla Individual Corporate DirectorBoard Member Jan 1, 2022
Michelle Calope Individual Corporate DirectorBoard Member Jan 1, 2023
Michael a Magro Individual Corporate OfficerPresident Jun 24, 2021
Shaila Kapur Individual Corporate DirectorBoard Member Jul 1, 2019
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 3, 2020 100%
Carmen O Larsen Individual Corporate DirectorBoard Member Jan 1, 2025
Trinity Health of the Mid-Atlantic Region Organization, Newtown Square, PA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 3, 2020 100%
Vincent D Gordon Individual Corporate OfficerChair Jan 1, 2025
Corporate DirectorBoard Member Jul 1, 2019
Catherine Mikus Individual Corporate OfficerSecretary Jan 1, 2021

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 158

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 158

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1124023015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522007",
            "telephone_number": "215-335-6000",
            "fax_number": "215-335-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522007",
            "telephone_number": "215-335-6000",
            "fax_number": "215-335-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAZARETH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "WAJDA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER, VP FINANCE",
        "authorized_official_telephone_number": "215-335-6043",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "400301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.