NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

Doing business as Temple Student and Employee Health

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1235701392
Registry record updated Jul 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
Temple Student and Employee Health
Practice address
1700 N Broad St
Philadelphia, PA 19121-3429
Phone
(215) 204-2679
Fax
(215) 204-1784
NPI assigned
Jul 16, 2021
Organization subpart
Yes
Parent organization
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2021

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

Authorized official

Name
Bridget Ferrarie
Title
Manager, Credentialing
Phone
(215) 707-2433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1700 N Broad St
Philadelphia, PA 19121-3429

Mailing address

1700 N Broad St
Philadelphia, PA 19121-3429
Phone (215) 204-2679

Other names 1

  • Temple Student and Employee Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211019001645 PA Part B Supplier - Clinic/Group Practice 2961314299 Receives reassigned benefits from 5 practitioners
Practice locations: Philadelphia, PA

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Temple Diag Imaging Ass28 organizations share this tax ID, including this one
Part of
Temple Diag Imaging Ass

Other organizations with this tax ID 27

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

View all 27

Locations

1700 N Broad St
Ste 4
Philadelphia, PA 19121
Phone (215) 204-2679

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1235701392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191213429",
            "telephone_number": "215-204-2679",
            "fax_number": "215-204-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191213429",
            "telephone_number": "215-204-2679",
            "fax_number": "215-204-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "enumeration_date": "2021-07-16",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "FERRARIE",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "215-707-2433"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Student and Employee Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.