Individual provider Active NPI

John Wesley Diddle, MD

  • Pediatric Critical Care Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1265548994
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
MD448317 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(215) 590-1858
Fax
(215) 590-1415
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ML20008453 WA
Pediatric Cardiology Physician 2080P0202X MD448317 PA
Pediatric Critical Care Medicine Physician 2080P0203X MD448317 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

3401 Civic Center Blvd Ste 9329
Philadelphia, PA 19104-4319
Phone (267) 425-9300

Other practice location 1

4401 Penn Ave
Suite 02000 Faculty Pavilion, Children's Hospital of Pi
Pittsburgh, PA 15224-1334
Phone (412) 692-5325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA, PA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20160810001945 DC Practitioner - Critical Care (Intensivists)Practitioner - Cardiovascular Disease (Cardiology) 9638246382 Reassigns benefits to 2 organizations
I20170411000204 VA Practitioner - Critical Care (Intensivists)Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 9638246382 Reassigns benefits to 1 organization
I20241115003512 PA Practitioner - Critical Care (Intensivists) 9638246382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
University of Tennessee, HSC, College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1858

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ML20008453WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince Feb 1, 2017 Accepting new patients
Children'S Hospital CurrentSince Jun 14, 2016 Accepting new patients
Children'S Anesthesiology Associates, LTD Pediatrics CurrentSince Sep 7, 2024 Accepting new patients
Children'S Anesthesiology Associates, LTD Current Accepting new patients
Inova Health Care Services Pediatrics CurrentSince Feb 1, 2017 Accepting new patients
Children'S Hospital Current Accepting new patients
Children'S Anesthesiology Associates, LTD Pediatrics CurrentSince Sep 7, 2024 Accepting new patients
Children'S Hospital Pediatrics CurrentSince Jun 14, 2016 Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1265548994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD STE 9329",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "267-425-9300",
            "fax_number": "267-443-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1858",
            "fax_number": "215-590-1415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 Penn Ave",
            "address_2": "Suite 02000 Faculty Pavilion, Children's Hospital of Pi",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152241334",
            "country_code": "US",
            "telephone_number": "412-692-5325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIDDLE",
        "first_name": "JOHN",
        "middle_name": "WESLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "ML20008453",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD448317",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "PA",
            "license": "MD448317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.