NPIMap

Organization Active NPI

Drexel University

Doing business as Drexel ID Partnership Clinic SPEC

  • Infectious Disease Physician
  • Philadelphia, PA
National Provider Identifier
1154590933
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
DREXEL UNIVERSITY
Doing business as
Drexel ID Partnership Clinic SPEC
Practice address
1427 Vine St
2ND Floor
Philadelphia, PA 19102-1031
Phone
(215) 762-2530
Fax
(215) 762-2531
NPI assigned
Feb 26, 2008
Last updated
Jun 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Authorized official

Name
Edward E Waldov
Title
Director of Revenue Cycle - Finance
Phone
(215) 255-7751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X Primary

Addresses

Primary practice location

1427 Vine St
2ND Floor
Philadelphia, PA 19102-1031

Mailing address

1601 Cherry St
Suite 11511
Philadelphia, PA 19102-1321
Phone (215) 255-7751

Other names 1

  • Drexel ID Partnership Clinic SPEC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140729001682 PA Part B Supplier - Clinic/Group Practice 5496664740 Receives reassigned benefits from 340 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Warminster, PA; Elkins Park, PA

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1154590933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CHERRY ST",
            "address_2": "SUITE 11511",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021321",
            "telephone_number": "215-255-7751",
            "fax_number": "215-255-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 VINE ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021031",
            "telephone_number": "215-762-2530",
            "fax_number": "215-762-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DREXEL UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "WALDOV",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE - FINANCE",
        "authorized_official_telephone_number": "215-255-7751"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drexel ID Partnership Clinic SPEC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Drexel ID Partnership Clinic SPEC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.