Individual provider Active NPI

Thomas Gallagher

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1194413203
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA064470 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(800) 879-2467
NPI assigned
Apr 26, 2023
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA064470 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

11 Easton Way
Hainesport, NJ 08036-4804
Phone (609) 850-1068

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231126000023 PA Practitioner - Physician Assistant 6305294711 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

5401 Old York Rd
Philadelphia, PA 19141-3030
Phone (215) 456-3930

5401 Old York Rd Klein BLDG
Phila, PA 19141-3030

5501 Old York Rd
Phila, PA 19141-3018

5501 Old York Rd Levy 2
Einstein Pediatrics Associates
Philadelphia, PA 19141-3018
Phone (215) 456-6786

5501 Old York Rd WCB 4TH FLR
Einstein CT Surgery Assoc
Philadelphia, PA 19141-3018
Phone (215) 456-8270

559 W Germantown Pike
East Norriton, PA 19403-4250

609 W Germantown Pike
East Norriton, PA 19403-4250

Einstein Surgical Assocs
700 West Germantown Pike
East Norriton, PA 19403-4250
Phone (484) 622-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc CurrentSince Oct 1, 2023 Accepting new patients
Einstein Practice Plan Inc CurrentSince Oct 1, 2023 Accepting new patients

Locations

101 E Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 254-2630

5401 Old York Rd
Ste 5
Philadelphia, PA 19141
Phone (215) 456-6127

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1682467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1194413203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EASTON WAY",
            "city": "HAINESPORT",
            "state": "NJ",
            "postal_code": "080364804",
            "telephone_number": "609-850-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "800-879-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA064470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.