Active NPI
Michael Andrew Panagos, MD
- Urology Physician
- Philadelphia, PA
National Provider Identifier
1255026605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MT228288
- Practice address
- 1025 Walnut St Ste 1100
Philadelphia, PA 19107-5001 - Phone
- (215) 955-1416
- Fax
- (215) 923-1884
- NPI assigned
- Apr 10, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Urology Physician | 208800000X | MT228288 | PA | Primary |
Addresses
Primary practice location
1025 Walnut St Ste 1100
Philadelphia, PA 19107-5001
Mailing address
1109 South St Apt D
Philadelphia, PA 19147-1960
Phone (240) 994-4741
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230605001812 | PA | Order and Referring Only - Urology | 7012374176 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT228288 | PA | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684627200000",
"number": "1255026605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1109 SOUTH ST APT D",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191471960",
"telephone_number": "240-994-4741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 WALNUT ST STE 1100",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075001",
"telephone_number": "215-955-1416",
"fax_number": "215-923-1884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANAGOS",
"first_name": "MICHAEL",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-10",
"last_updated": "2023-05-21",
"certification_date": "2023-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "PA",
"license": "MT228288",
"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 May 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.