Individual provider Active NPI

Elorm Fred Kenneth Avakame, MD

  • Critical Care Medicine (Anesthesiology) Physician
  • Philadelphia, PA
National Provider Identifier
1124524707
Registry record updated Sep 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
License
MD485475 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(267) 990-4476
NPI assigned
Apr 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X MD485475 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

2929 Arch St FL 12
Philadelphia, PA 19104-2857
Phone (267) 990-4476

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
I20241106001079 PA Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 5698209179 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD485475PAMDCritical Care Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Anesthesiology Associates, LTD Critical Care Medicine Current Accepting new patients
Children'S Anesthesiology Associates, LTD Critical Care Medicine CurrentSince Aug 26, 2024 Accepting new patients
Children'S Anesthesiology Associates, LTD CurrentSince Aug 26, 2024 Accepting new patients
Childrens Hospital of Philadelphia Past Accepting new patients

Locations

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

2929 Arch St
Fl 12
Philadelphia, PA 19104

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756684800000",
    "number": "1124524707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 ARCH ST FL 12",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042857",
            "telephone_number": "267-990-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "267-990-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVAKAME",
        "first_name": "ELORM",
        "middle_name": "FRED KENNETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2025-09-01",
        "certification_date": "2025-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "PA",
            "license": "MD485475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.