Individual provider Active NPI

Lisa Rosenthal Young, M.D.

  • Pediatric Pulmonology Physician
  • Philadelphia, PA
National Provider Identifier
1184672396
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
MD466754 Issued in PA
Practice address
3500 Civic Center Blvd
Philadelphia, PA 19104
Phone
(215) 590-1000
Fax
(267) 425-9299
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-079881 OH
Pulmonary Disease Physician 207RP1001X 35-079881 OH
Pulmonary Disease Physician 207RP1001X 47924 TN
Pediatrics Physician 208000000X 35-079881 OH
Pediatric Pulmonology Physician 2080P0214X 47924 TN
Pediatric Pulmonology Physician 2080P0214X 35-079881 OH
Pediatric Pulmonology Physician 2080P0214X MD466754 PA Primary

Addresses

Primary practice location

3500 Civic Center Blvd
Philadelphia, PA 19104

Mailing address

100 E Penn SQ FL 9
Philadelphia, PA 19107-3377
Phone (267) 425-9412

Other practice location 1

2200 Childrens Way
11215 Doctors Office Tower
Nashville, TN 37232-9500
Phone (615) 343-7617

Other practice location 2

2200 Childrens Way
Nashville, TN 37232-0005
Phone (615) 936-2000

Other identifiers 3

IdentifierTypeStateIssuer
64113665MedicaidKY
2592672MedicaidOH
200539670MedicaidIN

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
I20190729000410 PA Practitioner - Pediatric Medicine 5294752655 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-079881OHMDPulmonary Disease Physician
47924TNMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childen'S Health Care Associates Inc. CurrentSince Jun 2, 2019 Accepting new patients
Children'S Health Care Associates Pediatrics CurrentSince Jun 2, 2019 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childrens Health Care Associates of New Jersey PC Pediatrics Past Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1184672396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ FL 9",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073377",
            "telephone_number": "267-425-9412",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-1000",
            "fax_number": "267-425-9299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Childrens Way",
            "address_2": "11215 Doctors Office Tower",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372329500",
            "country_code": "US",
            "telephone_number": "615-343-7617",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320005",
            "country_code": "US",
            "telephone_number": "615-936-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "LISA",
        "middle_name": "ROSENTHAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-079881",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OH",
            "license": "35-079881",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TN",
            "license": "47924",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35-079881",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "TN",
            "license": "47924",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "OH",
            "license": "35-079881",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "PA",
            "license": "MD466754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64113665",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2592672",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200539670",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.