Active NPI
Corey Brisseau
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1194413039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OT024788
- Practice address
- 2601 Holme Ave
Philadelphia, PA 19152-2096 - Phone
- (215) 287-3818
- NPI assigned
- Apr 28, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OT024788 | PA | Primary |
Addresses
Primary practice location
2601 Holme Ave
Philadelphia, PA 19152-2096
Mailing address
5124 Arbor St
Philadelphia, PA 19120-3602
Phone (215) 287-3818
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785283200000",
"number": "1194413039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5124 ARBOR ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191203602",
"telephone_number": "215-287-3818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 HOLME AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191522096",
"telephone_number": "215-287-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISSEAU",
"first_name": "COREY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-28",
"last_updated": "2026-07-29",
"certification_date": "2026-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OT024788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.