Philadelphia Medical Group

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Legal business name

PHILADELPHIA MEDICAL GROUP

Doing business as

Philadelphia Medical Group

Practice address

8400 Roosevelt Blvd Ste 200
Philadelphia, PA 19152-2081

Phone

(215) 383-9936

NPI assigned

Oct 9, 2024

Last updated

Oct 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jermaine Parks

Title

President

Phone

(267) 304-3580

Specialties & licenses 1

Addresses

Other names 1

• Philadelphia Medical Group Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1215756978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 ROOSEVELT BLVD STE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522081",
            "telephone_number": "215-383-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 ROOSEVELT BLVD STE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522081",
            "telephone_number": "215-383-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "JERMAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-304-3580",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philadelphia Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health & Wellness Coach in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Health & Wellness Coach in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.