Active NPI
Jenny Pak
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1174220636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- SP026977
- Practice address
- 407 S 10TH St Ste 101
Philadelphia, PA 19147-1274 - Phone
- (215) 585-2342
- NPI assigned
- Feb 14, 2023
- Last updated
- Feb 14, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | SP026977 | PA | Primary |
Addresses
Primary practice location
407 S 10TH St Ste 101
Philadelphia, PA 19147-1274
Mailing address
1442 S Bouvier St
Philadelphia, PA 19146-4725
Phone (215) 760-9943
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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP026977 | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter Kelly LLC | Family Medicine | Current | Accepting new patients |
Locations
407 S 10th St
Ste 101
Philadelphia, PA 19147
Phone (212) 585-2342
Interoperability endpoints
- jenny.pak.1@25384.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1174220636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1442 S BOUVIER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191464725",
"telephone_number": "215-760-9943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 S 10TH ST STE 101",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191471274",
"telephone_number": "215-585-2342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAK",
"first_name": "JENNY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-14",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "SP026977",
"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 Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.