NPIMap

Organization Active NPI

South Philadelphia Pediatrics

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1235188475
Registry record updated Oct 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTH PHILADELPHIA PEDIATRICS
Practice address
1408 S. Broad Street Floor 2
Philadelphia, PA 19146
Phone
(215) 467-3515
Fax
(215) 467-0338
NPI assigned
May 7, 2006
Last updated
Oct 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2018

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

Authorized official

Name
Christine Nguyen, MDNPI 1508063918
Title
Partner
Phone
(215) 467-3515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

1408 S. Broad Street Floor 2
Philadelphia, PA 19146

Mailing address

1408 S. Broad Street Floor 2
Philadelphia, PA 19146
Phone (215) 467-3515

Other identifiers 5

IdentifierTypeStateIssuer
1027096410002MedicaidPA
1027571930001MedicaidPA
1027885740001MedicaidPA
1025843220001MedicaidPA
1027096140001MedicaidPA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0919090South Philadelphia Pediatrics, PC1408 S Broad St, 2ND Floor, Philadelphia, PA 19146Certificate of waiverApr 19, 2028

National Provider Directory

National Provider Directory

Locations

1408 S Broad St
#2
Philadelphia, PA 19146

1408 S Broad St
Ste 2
Philadelphia, PA 19146

528 S 2nd St
Ste 109
Philadelphia, PA 19147
Phone (215) 592-0715

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1146960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540425600000",
    "number": "1235188475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 S. BROAD STREET FLOOR 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-467-3515",
            "fax_number": "215-467-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 S. BROAD STREET FLOOR 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-467-3515",
            "fax_number": "215-467-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PHILADELPHIA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-07",
        "last_updated": "2018-10-25",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "215-467-3515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027096410002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027571930001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027885740001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025843220001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027096140001",
            "state": "PA"
        }
    ],
    "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 Oct 25, 2018; 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.