NPIMap

University of Penn-Medical Group

Organization Active NPI Gynecologic Oncology Physician · Philadelphia, PA

NPI 1235527342 · NPPES record last updated Aug 2, 2023

Key facts

NPI
1235527342
Entity type
Organization (NPI type 2)
Primary specialty
Gynecologic Oncology Physician 207VX0201X
Legal business name
UNIVERSITY OF PENN-MEDICAL GROUP
Practice address
3400 Civic Center Blvd
3Rd Floor
Philadelphia, PA 19104-5127
Phone
(215) 662-3318
NPI assigned
Dec 26, 2014
Organization subpart
No

Authorized official

Name
Chante L Jackson
Title
Enrollment Lead
Phone
(215) 662-6187

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 47

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 23

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

Practitioners 5,174

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 5,174

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20141111000091 PA Part B Supplier - Clinic/Group Practice 6204730955 Receives reassigned benefits from 3,792 practitioners
47 other NPIs on this enrollment

National Provider Directory

Tax ID family
Cobius Healthcare Solutions (24 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207VX0201X PA Yes

Addresses

Primary practice location

3400 Civic Center Blvd
3Rd Floor
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
3Rd Floor
Philadelphia, PA 19104-5127
Phone (215) 662-3318

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Other providers in Philadelphia, PA

All providers in Philadelphia, PA · Gynecologic Oncology Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.