Individual provider Active NPI

Maxwell Ambrosino, DO

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1265060164
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS022918 Issued in PA
Practice address
800 Spruce St
Philadelphia, PA 19107-6192
Phone
(215) 829-5410
NPI assigned
Mar 28, 2020
Last updated
Mar 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS022918 PA Primary

Addresses

Primary practice location

800 Spruce St
Philadelphia, PA 19107-6192

Mailing address

800 Spruce St
1 Pine West
Philadelphia, PA 19107-6130
Phone (215) 829-5410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230727001603 PA Practitioner - Internal Medicine 8820459506 Reassigns benefits to 1 organization
I20250325001589 NJ Practitioner - Internal Medicine 8820459506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiovascular Associates of the Delaware Valley,P aGroup PAC ID 9032001284, 94 clinicians

Practice addresses (Care Compare)

210 W Atlantic Ave
Haddon Heights, NJ 08035-1715
Phone (856) 546-3003

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS022918PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiovascular Associates of the Delaware Valley,P a CurrentSince May 1, 2025 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst CurrentSince Jul 5, 2023 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Jul 5, 2023 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Internal Medicine Current Accepting new patients

Locations

120 White Horse Pike
Ste 112
Haddon Hgts, NJ 08035
Phone 85654705392215

210 W Atlantic Ave
Haddon Hts, NJ 08035
Phone (856) 546-3003

800 Spruce St
Fl 1
Philadelphia, PA 19107
Phone (215) 829-5873

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

800 Spruce St
#1
William Penn Annex West, PA 19107
Phone (215) 829-2222

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1265060164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SPRUCE ST",
            "address_2": "1 PINE WEST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076130",
            "telephone_number": "215-829-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076192",
            "telephone_number": "215-829-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROSINO",
        "first_name": "MAXWELL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-28",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS022918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.