Individual provider Active NPI

Edmund A. Pribitkin, M.D.

  • Otolaryngology Physician
  • Philadelphia, PA
National Provider Identifier
1124044789
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD-039732-E Issued in PA
Practice address
925 Chestnut Street
6TH Floor
Philadelphia, PA 19107-4204
Phone
(215) 955-6760
Fax
(215) 923-4532
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD-039732-E PA Primary
Facial Plastic Surgery Physician 207YS0123X MD-039732-E PA

Addresses

Primary practice location

925 Chestnut Street
6TH Floor
Philadelphia, PA 19107-4204

Mailing address

925 Chestnut Street
6TH Floor
Philadelphia, PA 19107-4204
Phone (215) 955-6760

Other identifiers 2

IdentifierTypeStateIssuer
001298487MedicaidPA
5625301MedicaidNJ

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
I20041011000496 PA Practitioner - Otolaryngology 2365402757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Perelman School of Med at the University of Pennsylvania, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

925 Chestnut St
FL 6
Philadelphia, PA 19107-4204
Phone (215) 955-6760

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-039732-EPAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Otolaryngology CurrentSince Nov 5, 1992 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

909 Walnut St
Fl 3
Philadelphia, PA 19107
Phone (215) 503-7008

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

1101 Chestnut St
Fl 16
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

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 1

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": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1124044789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT STREET",
            "address_2": "6TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074204",
            "telephone_number": "215-955-6760",
            "fax_number": "215-923-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT STREET",
            "address_2": "6TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074204",
            "telephone_number": "215-955-6760",
            "fax_number": "215-923-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIBITKIN",
        "first_name": "EDMUND",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD-039732-E",
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "PA",
            "license": "MD-039732-E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001298487",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5625301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.