NPIMap

Organization Active NPI

Trustees of the University of Pennsylvania

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1124882949
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Practice address
51 N 39TH St
Philadelphia, PA 19104-2640
Phone
(215) 662-8000
NPI assigned
Feb 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Chante L Jackson
Title
Payer Supervisor
Phone
(267) 207-7303

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

51 N 39TH St
Philadelphia, PA 19104-2640

Mailing address

51 N 39TH St
Philadelphia, PA 19104-2640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240424002545 PA Part B Supplier - Clinic/Group Practice 2062326507 Receives reassigned benefits from 193 practitioners
Practice locations: Radnor, PA; Philadelphia, PA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations (25 of 26)

798 Woodlane Rd
Westampton, NJ 08060
Phone (609) 265-9339

599 W State St
Doylestown, PA 18901
Phone (215) 345-2885

700 W Lincoln Hwy
Ste 716
Exton, PA 19341
Phone (610) 269-2629

625 Clark Ave
Ste 657
King of Prussia, PA 19406
Phone (800) 666-6002

10 E Swedesford Rd
Malvern, PA 19355

3400 Spruce St
Fl 6
Philadelphia, PA 19104
Phone (215) 615-0800

3701 Market St
Fl 6
Philadelphia, PA 19104
Phone (215) 662-2250

3020 Market St
Ste 220
Philadelphia, PA 19104
Phone (215) 349-8178

3020 Market St
Ste 202
Philadelphia, PA 19104
Phone (215) 349-8178

3250 S 76th St
Ste 400
Philadelphia, PA 19153
Phone (215) 594-8100

230 W Washington Sq
Fl 3
Philadelphia, PA 19106
Phone (215) 829-5064

4122 Market St
Philadelphia, PA 19104
Phone (833) 983-1350

250 King of Prussia Rd
#2A
Radnor, PA 19087
Phone (610) 902-2500

250 King of Prussia Rd
#6
Radnor, PA 19087
Phone (610) 902-2000

250 King of Prussia Rd
Slp Med
Radnor, PA 19087
Phone (610) 902-5600

250 King of Prussia Rd
Fl 2
Radnor, PA 19087
Phone (610) 902-1800

250 King of Prussia Rd
#2F
Radnor, PA 19087
Phone (610) 902-5600

250 King of Prussia Rd
#2E
Radnor, PA 19087
Phone (610) 902-5600

250 King of Prussia Rd
#2B
Radnor, PA 19087
Phone (610) 902-2400

250 King of Prussia Rd
#1A
Radnor, PA 19087
Phone (610) 902-2020

440 E Marshall St
Ste 155
West Chester, PA 19380
Phone (610) 738-2550

440 E Marshall St
Ste 101
West Chester, PA 19380
Phone (610) 738-2500

1000 Floral Vale Blvd
Ste 100
Yardley, PA 19067
Phone (215) 752-4020

777 Township Line Rd
Ste 150
Yardley, PA 19067
Phone (215) 860-3360

777 Township Line Rd
Ste 310
Yardley, PA 19067
Phone (215) 752-2424

Ownership & related parties

All facility ownership & control disclosures 17

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Penn Medicine Princeton Medical CenterPlainsboro, NJ, CCN 310010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Lancaster General HospitalLancaster, PA, CCN 390100 Hospital 5% Or Greater Indirect Ownership Interest Aug 1, 2015
Hospital of the University of PennsylvaniaPhiladelphia, PA, CCN 390111 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 18, 2007
Oct 18, 2007
Hospital of the University of PennsylvaniaPhiladelphia, PA, CCN 39T111 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 16, 2007
Nov 16, 2017
The Pennsylvania Hospital of the University of Pennsylvania Health SysPhiladelphia, PA, CCN 390226 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 30, 1997
The Pennsylvania Hospital of the University of Pennsylvania Health SysPhiladelphia, PA, CCN 39S226 Hospital 5% Or Greater Direct Ownership Interest Apr 30, 1997
Penn Presbyterian Medical CenterPhiladelphia, PA, CCN 390223 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 13, 1995
Penn Medicine | Good Shepherd RehabilitationPhiladelphia, PA, CCN 392050 Hospital Other (49%) Jul 1, 2019
Chester County HospitalWest Chester, PA, CCN 390179 Hospital 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2013
Penn Medicine Princeton Medical Center Acute Rehabilitation CenterPlainsboro, NJ, CCN 31T010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine Princeton House Behavioral HealthPlainsboro, NJ, CCN 31S010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Lancaster Behavioral Health HospitalLancaster, PA, CCN 394055 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 7, 2014
Rittenhouse Post AcutePhiladelphia, PA, CCN 395749 Skilled nursing facility Adp of the SNF Sep 12, 2024
Penn Medicine Home HealthBala Cynwyd, PA, CCN 397125 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jun 13, 1995
Penn Medicine Home Health Princeton HealthPrinceton, NJ, CCN 317045 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine Hospice Princeton HealthPrinceton, NJ, CCN 311506 Hospice 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine HospiceBala Cynwyd, PA, CCN 391501 Hospice 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1997

Owned or controlled facilities with NPI records 20

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 20

Practitioners & affiliated clinicians

Practitioners 507

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

View all 507

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1124882949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHANTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PAYER SUPERVISOR",
        "authorized_official_telephone_number": "267-207-7303"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.