Individual provider Active NPI

Paul Jacob Ufberg, DO, MBA

  • Pediatric Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1124265004
Registry record updated Nov 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
OS013980 Issued in PA
Practice address
3401 Civic Center Blvd
Childrens Hospital of Philadelphia Chca Gastro
Philadelphia, PA 19104-4319
Phone
(215) 590-3247
Fax
(215) 590-3606
NPI assigned
Jan 14, 2009
Last updated
Nov 11, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X OS013980 PA Primary
Pediatric Gastroenterology Physician 2080P0206X 005201 AZ
Pediatric Gastroenterology Physician 2080P0206X DO2327 ME

Addresses

Primary practice location

3401 Civic Center Blvd
Childrens Hospital of Philadelphia Chca Gastro
Philadelphia, PA 19104-4319

Mailing address

100 E Penn SQ
9TH FL North Tower
Philadelphia, PA 19107-3323
Phone (267) 425-9232

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
I20151022002505 PA Practitioner - Pediatric MedicinePractitioner - Gastroenterology 8325192008 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Business Administration

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Current Accepting new patients
Childen's Health Care Associates Inc. CurrentSince Oct 1, 2015 Accepting new patients
St. Luke's Physician Group, Inc. Family Medicine Current Accepting new patients
St Luke's Physician Group Inc Family Medicine CurrentSince May 1, 2022 Accepting new patients
St. Luke's Physician Group, Inc. CurrentSince May 1, 2022 Accepting new patients
Childrens Health Care Associates, Inc Pediatric Gastroenterology CurrentSince Oct 1, 2015 Accepting new patients

Locations

701 Ostrum St
Ste 102
Fountain Hill, PA 18015
Phone (484) 526-7575

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447200000000",
    "number": "1124265004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FL NORTH TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9232",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHILDRENS HOSPITAL OF PHILADELPHIA CHCA GASTRO",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-3247",
            "fax_number": "215-590-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UFBERG",
        "first_name": "PAUL",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DO, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-14",
        "last_updated": "2015-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "OS013980",
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AZ",
            "license": "005201",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "ME",
            "license": "DO2327",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.