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University of Penn-Medical Group

Organization Active NPI Internal Medicine Physician · Philadelphia, PA

NPI 1255729364 · NPPES record last updated Nov 19, 2020

Key facts

NPI
1255729364
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
UNIVERSITY OF PENN-MEDICAL GROUP
Practice address
3400 Spruce St
19 Penn Tower
Philadelphia, PA 19104-4238
Phone
(215) 662-3285
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

Corporate family (same tax ID) 23

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

Practitioners 65

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

View all 65

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
This NPI is an additional NPI on the enrollment

National Provider Directory

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

Locations

3400 Spruce St
#19
Philadelphia, PA 19104
Phone (215) 662-3285

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X PA Yes

Addresses

Primary practice location

3400 Spruce St
19 Penn Tower
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
19 Penn Tower
Philadelphia, PA 19104-4238
Phone (215) 662-3285

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 · Internal Medicine Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.