Individual provider Active NPI

Alexander Heromin, MD

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1124556311
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
TMD004893 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 955-6000
NPI assigned
Jun 1, 2017
Last updated
Aug 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X TMD004893 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

1020 Sansom St Ste 239
Philadelphia, PA 19107-5002
Phone (215) 955-3921

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
I20200807002926 PA Practitioner - Emergency Medicine 8325318322 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Acute Care Physicians, PC CurrentSince Jul 1, 2020 Accepting new patients
Jefferson University Physicians Single Specialty CurrentSince Jul 1, 2020 Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Jul 1, 2020 Accepting new patients
Jefferson Acute Care Physicians, PC Single Specialty Current Accepting new patients

Locations

1020 Sansom St
Ste 239
Philadelphia, PA 19107
Phone (215) 955-6844

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

2301 S Broad St
Fl 1
Philadelphia, PA 19148
Phone (215) 952-9136

700 Walnut St
Philadelphia, PA 19106
Phone (215) 503-7300

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

Interoperability endpoints

  • Direct secure messaging: alex.heromin.1@24265.direct.athenahealth.com

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, 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": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1124556311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 SANSOM ST STE 239",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075002",
            "telephone_number": "215-955-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEROMIN",
        "first_name": "ALEXANDER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "TMD004893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.