NPIMap

Organization Active NPI

Davita Medical Group Philadelphia, LLC

  • Internal Medicine Physician
  • Conshohocken, PA
National Provider Identifier
1194297127
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DAVITA MEDICAL GROUP PHILADELPHIA, LLC
Practice address
300 W 4TH Ave Ste 260
Conshohocken, PA 19428-1607
Phone
(215) 568-4678
NPI assigned
Jan 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

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

Authorized official

Name
Michael Terrence Werner
Title
Sr. Director of Operations
Phone
(215) 568-4678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

300 W 4TH Ave Ste 260
Conshohocken, PA 19428-1607

Mailing address

300 W 4TH Ave Ste 260
Conshohocken, PA 19428-1607

Other names 1

  • Tandigm Care Services (BH) Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Davita Medical Group Philadelphia LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546387200000",
    "number": "1194297127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W 4TH AVE STE 260",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194281607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W 4TH AVE STE 260",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194281607",
            "telephone_number": "215-568-4678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVITA MEDICAL GROUP PHILADELPHIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-02",
        "last_updated": "2019-01-02",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "TERRENCE",
        "authorized_official_title_or_position": "SR. DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "215-568-4678"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tandigm Care Services (BH)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conshohocken, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.