Individual provider Active NPI

Pavel Itersky, DO

  • Endocrinology, Diabetes & Metabolism Physician
  • Philadelphia, PA
National Provider Identifier
1205332251
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
OS021983 Issued in PA
Practice address
9501 Roosevelt Blvd Ste 300
Philadelphia, PA 19114-1028
Phone
(215) 969-9511
Fax
(215) 969-9512
NPI assigned
Mar 30, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X OS021983 PA
Student in an Organized Health Care Education/Training Program 390200000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X OS021983 PA Primary

Addresses

Primary practice location

9501 Roosevelt Blvd Ste 300
Philadelphia, PA 19114-1028

Mailing address

9501 Roosevelt Blvd Ste 300
Philadelphia, PA 19114-1028
Phone (215) 969-9511

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
I20220524001146 PA Practitioner - Internal Medicine 8224460019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aria Health Physician ServicesGroup PAC ID 3577467018, 456 clinicians

Practice addresses (Care Compare)

10800 Knights Rd
Philadelphia, PA 19114-4200
Phone (215) 612-4000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Health Physician Services CurrentSince May 17, 2025 Accepting new patients
Aria Health Physician Services Current Accepting new patients
Aria Health Physician Services PastSince Jul 1, 2022 Accepting new patients

Locations

1101 Market St
Fl 19
Philadelphia, PA 19107
Phone (215) 481-6836

10800 Knights Rd
Philadelphia, PA 19114
Phone (215) 612-2610

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 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": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1205332251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 ROOSEVELT BLVD STE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141028",
            "telephone_number": "215-969-9511",
            "fax_number": "215-969-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 ROOSEVELT BLVD STE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141028",
            "telephone_number": "215-969-9511",
            "fax_number": "215-969-9512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITERSKY",
        "first_name": "PAVEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-30",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "OS021983",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "PA",
            "license": "OS021983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.