NPIMap

Organization Active NPI

Pinnacle Physicians Group, LLC

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1215351044
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PINNACLE PHYSICIANS GROUP, LLC
Practice address
9908 Roosevelt Blvd
Philadelphia, PA 19115-1705
Phone
(215) 464-3300
Fax
(215) 464-5403
NPI assigned
Feb 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Authorized official

Name
Carole Medoff
Title
Executive Director
Phone
(215) 435-1709

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X

Addresses

Primary practice location

9908 Roosevelt Blvd
Philadelphia, PA 19115-1705

Mailing address

9908 Roosevelt Blvd
Philadelphia, PA 19115-1705
Phone (215) 464-3300

Other identifiers 4

IdentifierTypeStateIssuer
1027993620001MedicaidPA
3033848OtherPAHIGHMARK BLUECROSS
3915101000OtherPAINDEPENDENCE BLUECROSS
248882OtherPAMEDICARE GROUP PTAN

Other names 1

  • MNAP Diagnostic Imaging Other name

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Physicians GRP LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1215351044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9908 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191151705",
            "telephone_number": "215-464-3300",
            "fax_number": "215-464-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9908 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191151705",
            "telephone_number": "215-464-3300",
            "fax_number": "215-464-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE PHYSICIANS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "MEDOFF",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "215-435-1709"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027993620001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUECROSS",
            "identifier": "3033848",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUECROSS",
            "identifier": "3915101000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "248882",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MNAP Diagnostic Imaging",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 29, 2014; 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.