Individual provider Active NPI

Georgene Ellen Hergenroeder, MD

  • Pediatric Pulmonology Physician
  • Philadelphia, PA
National Provider Identifier
1225560352
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
MD480615 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-3364
Phone
(215) 590-3749
NPI assigned
Mar 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X MD480615 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-3364

Mailing address

3401 Civic Center Blvd
Suite M975
Philadelphia, PA 19104-3364
Phone (713) 517-0028

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
I20231108000284 PA Practitioner - Pulmonary Disease 1153752183 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Childen'S Health Care Associates Inc. CurrentSince Sep 25, 2023 Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Sep 5, 2023 Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Sep 25, 2023 Accepting new patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients

Locations

3401 Civic Center Blvd
Ste M975
Philadelphia, PA 19104
Phone (215) 327-4964

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3401 Civic Center Blvd
#M975
Philadelphia, PA 19104

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1225560352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "SUITE M975",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043364",
            "telephone_number": "713-517-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043364",
            "telephone_number": "215-590-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERGENROEDER",
        "first_name": "GEORGENE",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "PA",
            "license": "MD480615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.