NPIMap

Organization Active NPI

Nazareth Hospital

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1215064704
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NAZARETH HOSPITAL
Practice address
2601 Holme Ave
Philadelphia, PA 19152-2007
Phone
(215) 335-6043
Fax
(215) 335-6303
NPI assigned
Feb 28, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. David A Wajda
Title
V. P. of Finance Cfo
Phone
(215) 335-6043

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 7

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

Practitioners 11

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Hospital certification: CCN 390204A

Medicare enrollment files
Legal name
NAZARETH HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Nov 15, 1994 in PA
Enrollment address
2601 Holme Avenue
Philadelphia, PA 19152-2007
Main/Primary Hospital Location
Hospital subgroups
Acute care, Rehabilitation

All disclosed owners & managing parties 23

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marianne Grace Individual Corporate DirectorBoard Member Jan 1, 2022
Geraldine Hoyler Individual Corporate DirectorBoard Member Jan 1, 2026
James M Monihan Individual Corporate DirectorBoard Member Jan 1, 2020
Julie Keese Individual Corporate OfficerTreasurer and VP, Finance and CF Jun 21, 2025
W-2 Managing EmployeeVP, Finance and Cfo Jun 21, 2025
Sandra Lynn Kweder Individual Corporate DirectorBoard Member Jan 1, 2025
Jacqueline a Watson Individual Corporate DirectorBoard Member Jan 1, 2025
Julie Washington Individual Corporate DirectorBoard Member Jul 1, 2020
Ajay K Gupta Individual Corporate OfficerVice-Chair Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2025
Barbara Buckley Individual Corporate DirectorBoard Member Jan 1, 2022
Leena Alex Individual Corporate OfficerDirector Finance Operations Jan 6, 2025
Larry Warren Individual Corporate DirectorBoard Member Jan 1, 2025
Robin W Madden Individual Corporate DirectorBoard Member Jan 1, 2025
Laura Williams Individual Corporate OfficerRegional Manager of Medical Group Jan 1, 2025
W-2 Managing EmployeeRegional Manager of Medical Group Jan 1, 2025
Andre Boyd Individual Corporate OfficerPresident and Ceo Jan 6, 2025
Corporate DirectorBoard Member Jan 6, 2025
Hiral P Fontanilla Individual Corporate DirectorBoard Member Jan 1, 2022
Michelle Calope Individual Corporate DirectorBoard Member Jan 1, 2023
Michael a Magro Individual Corporate OfficerPresident Jun 24, 2021
Shaila Kapur Individual Corporate DirectorBoard Member Jul 1, 2019
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 3, 2020 100%
Carmen O Larsen Individual Corporate DirectorBoard Member Jan 1, 2025
Trinity Health of the Mid-Atlantic Region Organization, Newtown Square, PA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 3, 2020 100%
Vincent D Gordon Individual Corporate OfficerChair Jan 1, 2025
Corporate DirectorBoard Member Jul 1, 2019
Catherine Mikus Individual Corporate OfficerSecretary Jan 1, 2021

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20080221000520 PA Part a Provider - Hospital 1951202910 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Tax ID family
Nazareth Hospital (8 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

NPPES NPI Registry

Primary practice location

2601 Holme Ave
Philadelphia, PA 19152-2007

Mailing address

2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (215) 335-6043

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
1007654720015MedicaidPA
1007654720013MedicaidPA
1007654720010MedicaidPA
1007654720011MedicaidPA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215064704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522007",
            "telephone_number": "215-335-6043",
            "fax_number": "215-335-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522007",
            "telephone_number": "215-335-6043",
            "fax_number": "215-335-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAZARETH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAJDA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "V. P. OF FINANCE  CFO",
        "authorized_official_telephone_number": "215-335-6043",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007654720015",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007654720013",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007654720010",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007654720011",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.