Individual provider Active NPI

Alan T. Forstater, M.D.

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1174548077
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD-017348-E Issued in PA
Practice address
1020 Sansom Street
Suite 239
Philadelphia, PA 19107-5004
Phone
(215) 955-6844
Fax
(215) 955-2526
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD-017348-E PA Primary

Addresses

Primary practice location

1020 Sansom Street
Suite 239
Philadelphia, PA 19107-5004

Mailing address

1020 Sansom St
Suite 239
Philadelphia, PA 19107-5002

Other identifiers 2

IdentifierTypeStateIssuer
2137101MedicaidNJ
000968418MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040928000862 PA Practitioner - Internal Medicine 3870562713 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-017348-EPAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Acute Care Physicians, PC CurrentSince Jan 3, 2017 Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Jan 3, 2017 Accepting new patients

Locations

700 Walnut St
Philadelphia, PA 19106
Phone (215) 503-7300

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1174548077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 SANSOM ST",
            "address_2": "SUITE 239",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 SANSOM STREET",
            "address_2": "SUITE 239",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075004",
            "telephone_number": "215-955-6844",
            "fax_number": "215-955-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSTATER",
        "first_name": "ALAN",
        "middle_name": "T.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD-017348-E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2137101",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968418",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.