Individual provider Active NPI

Aja Jackson Devose, D.O.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1174863054
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OTO14993 Issued in PA
Practice address
220 W Chelten Ave
Philadelphia, PA 19144-3803
Phone
(215) 310-7022
NPI assigned
Feb 28, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OTO14993 PA Primary

Addresses

Primary practice location

220 W Chelten Ave
Philadelphia, PA 19144-3803

Mailing address

PO Box 746722
Atlanta, GA 30374-6722
Phone (312) 733-9730

Other practice location 1

5901 Market St
Philadelphia, PA 19139-3117
Phone (215) 528-5600

Other practice location 2

2401 W Cheltenham Ave
Wyncote, PA 19095-2946
Phone (215) 444-7471

Other names 1

  • Aja Jackson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aja.jackson.1@16196.direct.athenahealth.com Direct Mercy Management of Southeastern Pennsylvani

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
I20160310000108 PA Practitioner - Family Practice 6507162047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh - PA Physicians Group, PCGroup PAC ID 7517213879, 113 clinicians

Practice addresses (Care Compare)

2401 W Cheltenham Ave
Wyncote, PA 19095-2946
Phone (312) 600-8484

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OTO14993PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osh - PA Physicians Group, PC Family Medicine CurrentSince Sep 26, 2022 Accepting new patients

Locations

3621 Aramingo Ave
Philadelphia, PA 19134
Phone (312) 600-8484

220 W Chelten Ave
Philadelphia, PA 19144
Phone (215) 310-7022

2401 W Cheltenham Ave
Wyncote, PA 19095
Phone (215) 444-7471

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1174863054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746722",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746722",
            "telephone_number": "312-733-9730",
            "fax_number": "773-866-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W CHELTEN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191443803",
            "telephone_number": "215-310-7022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 Market St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191393117",
            "country_code": "US",
            "telephone_number": "215-528-5600",
            "fax_number": "215-528-5700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2401 W Cheltenham Ave",
            "address_purpose": "LOCATION",
            "city": "Wyncote",
            "state": "PA",
            "postal_code": "190952946",
            "country_code": "US",
            "telephone_number": "215-444-7471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON DEVOSE",
        "first_name": "AJA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-28",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OTO14993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aja.jackson.1@16196.direct.athenahealth.com",
            "affiliation": "Y",
            "endpointDescription": "Mercy Management of Southeastern Pennsylvania Direct Email Address",
            "affiliationName": "Mercy Management of Southeastern Pennsylvani",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "5901 Market St",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191393117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AJA",
            "last_name": "JACKSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.