Individual provider Active NPI

Jeffrey William McCann

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1124260054
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD436196 Issued in PA
Practice address
111 S 11TH St
Suite 3390
Philadelphia, PA 19107-4824
Phone
(215) 955-6226
Fax
(215) 923-1562
NPI assigned
Mar 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD436196 PA Primary

Addresses

Primary practice location

111 S 11TH St
Suite 3390
Philadelphia, PA 19107-4824

Mailing address

615 Chestnut St
14TH Floor
Philadelphia, PA 19106-4404
Phone (215) 955-2141

Other identifiers 2

IdentifierTypeStateIssuer
1022806590001MedicaidPA
0190811MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242172800000",
    "number": "1124260054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 CHESTNUT ST",
            "address_2": "14TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191064404",
            "telephone_number": "215-955-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 3390",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6226",
            "fax_number": "215-923-1562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCANN",
        "first_name": "JEFFREY",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD436196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022806590001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190811",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.