NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

  • Plastic Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1174511273
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
Temple Plastic Surgery Associates
Practice address
3401 N Broad St
Philadelphia, PA 19140
Phone
(215) 707-3933
Fax
(215) 707-2531
NPI assigned
Oct 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Authorized official

Name
Tonya Woodard
Title
Manager, Credentialing
Phone
(215) 707-3911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-3933

Other practice location 1

1501 Lansdowne Ave
Darby, PA 19023-1333
Phone (610) 534-6300

Other practice location 2

2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (215) 707-3933

Other practice location 3

255 S 17th St
Philadelphia, PA 19103-6231
Phone (215) 875-2200

Other practice location 4

515 Pennsylvania Ave
Fort Washington, PA 19034-3314
Phone (215) 707-3933

Other practice location 5

888 Glenbrook ave
fort washington, PA 19034-3303
Phone (610) 525-5003

Other practice location 6

8815 Germantown Ave
Philadelphia, PA 19118-2722
Phone (215) 247-7740

Other practice location 7

7500 Central Ave
Philadelphia, PA 19111-2430
Phone (215) 214-4100

Other identifiers 8

IdentifierTypeStateIssuer
1007780130782MedicaidPA
1007780130781MedicaidPA
1007780130780MedicaidPA
1007780130776MedicaidPA
1007780130778MedicaidPA
1007780130122MedicaidPA
1007780130777MedicaidPA
1007780130779MedicaidPA

Other names 1

  • Temple Plastic Surgery Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000333 PA Part B Supplier - Clinic/Group Practice 2961314299 Receives reassigned benefits from 19 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

2450 W Hunting Park Ave
Fl 3
Philadelphia, PA 19129
Phone (215) 707-3633

3322 N Broad St
Ste 300
Philadelphia, PA 19140

3322 N Broad St
Fl 3
Philadelphia, PA 19140

8815 Germantown Ave
Ste 36
Philadelphia, PA 19118
Phone (215) 242-5300

7500 Central Ave
Ste 201
Philadelphia, PA 19111
Phone (215) 214-4100

3509 N Broad St
Fl 6
Philadelphia, PA 19140
Phone (215) 707-6410

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1174511273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19140",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Lansdowne Ave",
            "address_purpose": "LOCATION",
            "city": "Darby",
            "state": "PA",
            "postal_code": "190231333",
            "country_code": "US",
            "telephone_number": "610-534-6300",
            "fax_number": "610-534-6297",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 Holme Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191522007",
            "country_code": "US",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "255 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191036231",
            "country_code": "US",
            "telephone_number": "215-875-2200",
            "fax_number": "215-875-9714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-3933",
            "fax_number": "215-707-2531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "888 Glenbrook ave",
            "address_purpose": "LOCATION",
            "city": "fort washington",
            "state": "PA",
            "postal_code": "190343303",
            "country_code": "US",
            "telephone_number": "610-525-5003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8815 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191182722",
            "country_code": "US",
            "telephone_number": "215-247-7740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7500 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112430",
            "country_code": "US",
            "telephone_number": "215-214-4100",
            "fax_number": "215-214-4124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130782",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130781",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130780",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130776",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130778",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130122",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130777",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130779",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Plastic Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Plastic Surgery Associates",
            "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 15, 2018; 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.