NPIMap

Individual provider Active NPI

Joseph Mark Boselli, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1154377893
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD030504E Issued in PA
Practice address
205 North Broad Street
Suite 100
Philadelphia, PA 19107
Phone
(215) 587-8008
Fax
(215) 587-6248
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD030504E PA Primary

Addresses

Primary practice location

205 North Broad Street
Suite 100
Philadelphia, PA 19107

Mailing address

205 North Broad Street
Suite 100
Philadelphia, PA 19107
Phone (215) 587-8008

Other identifiers 1

IdentifierTypeStateIssuer
1048608010MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091103000254 PA Practitioner - Internal Medicine 9638216120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Hahnemann University College of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1101 Market St
FL 19
Philadelphia, PA 19107-2926

205 N Broad St 1St Floor
Jefferson Internal Medicine Assocs
Philadelphia, PA 19107-1554
Phone (215) 587-8008

925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874

Hospital & facility affiliations

  • Jefferson Health at Home by Bayada Home health agency, Philadelphia, PA, CCN 397643
  • Mercy Home Health Home health agency, Newtown, PA, CCN 397015
  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086
  • Good Shepherd Penn Partners Long-term care hospital, Philadelphia, PA, CCN 392050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD030504EPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

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

Organizations & group practices 2

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1154377893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 NORTH BROAD STREET",
            "address_2": "SUITE 100",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-587-8008",
            "fax_number": "215-587-6248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NORTH BROAD STREET",
            "address_2": "SUITE 100",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-587-8008",
            "fax_number": "215-587-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSELLI",
        "first_name": "JOSEPH",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD030504E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1048608010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.