Individual provider Active NPI

Gaia Coppock, MD

  • Nephrology Physician
  • Philadelphia, PA
National Provider Identifier
1164656351
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD452354 Issued in PA
Practice address
3400 Spruce Street
1 Founders
Philadelphia, PA 19104
Phone
(215) 662-2638
NPI assigned
May 4, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD452354 PA Primary

Addresses

Primary practice location

3400 Spruce Street
1 Founders
Philadelphia, PA 19104

Mailing address

3400 Spruce Street
1 Founders
Philadelphia, PA 19104
Phone (215) 662-2638

Other names 1

  • Gaia Muallem Former name

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
I20140807000309 PA Practitioner - Nephrology 2567689094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Texas Medical School at Houston, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

145 King of Prussia Rd
Suite 205
Radnor, PA 19087-4557
Phone (610) 902-4861

3400 Spruce St 210 White BLDG
Renal Electrolyte Hup
Philadelphia, PA 19104-4228
Phone (215) 662-2638

3400 Spruce St 210 White Building
Renal Electrolyte Hup
Philadelphia, PA 19104-4228
Phone (215) 662-2638

Hospital & facility affiliations

  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Chester County Hospital Hospital, West Chester, PA, CCN 390179
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Nephrology CurrentSince Jul 1, 2014 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2014 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

PO B0x 824320
Philadelphia, PA 19182

3400 Spruce St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-3005

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

145 King of Prussia Rd
Ste 205
Wayne, PA 19087
Phone (610) 902-4858

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1241395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1164656351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "1 FOUNDERS",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-2638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "1 FOUNDERS",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-2638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOCK",
        "first_name": "GAIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-04",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD452354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GAIA",
            "last_name": "MUALLEM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.