Active NPI
Michael A Rackover, PA-C
- Physician Assistant
- Philadelphia, PA
National Provider Identifier
1225387012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA000744L
- Practice address
- 4201 Henry Ave
Philadelphia, PA 19144-5409 - Phone
- (215) 951-2676
- NPI assigned
- Sep 7, 2012
- Last updated
- Sep 7, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA000744L | PA | Primary |
Addresses
Primary practice location
4201 Henry Ave
Philadelphia, PA 19144-5409
Mailing address
557 Franklin Way
West Chester, PA 19380-5711
Phone (484) 266-0473
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA000744L | PA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1225387012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "557 FRANKLIN WAY",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193805711",
"telephone_number": "484-266-0473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 HENRY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191445409",
"telephone_number": "215-951-2676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RACKOVER",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-07",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA000744L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.