Individual provider Active NPI

Millen Worku Gebreselassie, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1275646234
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD423447 Issued in PA
Practice address
1900 N 20TH St
Health Care Center #5
Philadelphia, PA 19121-2217
Phone
(215) 685-2933
Fax
(215) 765-2409
NPI assigned
Aug 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD423447 PA Primary

Addresses

Primary practice location

1900 N 20TH St
Health Care Center #5
Philadelphia, PA 19121-2217

Mailing address

500 S Broad St
Suite 360
Philadelphia, PA 19146-1613
Phone (215) 685-6769

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041119001002 PA Practitioner - Family Practice 9537124482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Drexel University College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of PhiladelphiaGroup PAC ID 6305758723, 86 clinicians

Practice addresses (Care Compare)

2230 Cottman Ave
Philadelphia, PA 19149-1230
Phone (215) 685-0602

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City of Philadelphia CurrentSince Mar 22, 2011 Accepting new patients
City of Philadelphia CurrentSince Mar 22, 2011 Accepting new patients
City of Philadelphia Current Accepting new patients
City of Philadelphia Past Accepting new patients

Locations

1101 Market St
Fl 10
Philadelphia, PA 19107

1900 N 20th St
#5
Philadelphia, PA 19121
Phone (215) 685-2933

2230 Cottman Ave
Philadelphia, PA 19149
Phone (215) 685-0603

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

500 S Broad St
Ste 360
Philadelphia, PA 19146

Interoperability endpoints

  • Direct secure messaging: millen.gebreselassie@pdphahs.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275646234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S BROAD ST",
            "address_2": "SUITE 360",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461613",
            "telephone_number": "215-685-6769",
            "fax_number": "215-685-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 N 20TH ST",
            "address_2": "HEALTH CARE CENTER #5",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191212217",
            "telephone_number": "215-685-2933",
            "fax_number": "215-765-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEBRESELASSIE",
        "first_name": "MILLEN",
        "middle_name": "WORKU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD423447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.