NPIMap

Organization Active NPI

Broad Street Medical LLC

  • Vascular Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1124670922
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
BROAD STREET MEDICAL LLC
Practice address
2033 S Broad St Ste B
Philadelphia, PA 19148-5505
Phone
(215) 809-1447
Fax
(224) 235-4652
NPI assigned
Jul 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Ami Almeda
Title
Credentialing Manager
Phone
(224) 318-0118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

2033 S Broad St Ste B
Philadelphia, PA 19148-5505

Mailing address

PO Box 302
Northbrook, IL 60065-0302
Phone (847) 593-8460

National Provider Directory

National Provider Directory

Locations

2033 S Broad St
Ste B
Philadelphia, PA 19148
Phone (215) 809-1447

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1124670922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 302",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600650302",
            "telephone_number": "847-593-8460",
            "fax_number": "224-235-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 S BROAD ST STE B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191485505",
            "telephone_number": "215-809-1447",
            "fax_number": "224-235-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "ALMEDA",
        "authorized_official_first_name": "AMI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "224-318-0118"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 11, 2019; 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.