NPIMap

University of Penn-Medical Group

Organization Active NPI Sports Medicine (Internal Medicine) Physician · Philadelphia, PA

NPI 1285022202 · NPPES record last updated Nov 19, 2020

Key facts

NPI
1285022202
Entity type
Organization (NPI type 2)
Primary specialty
Sports Medicine (Internal Medicine) Physician 207RS0010X
Legal business name
UNIVERSITY OF PENN-MEDICAL GROUP
Practice address
3737 Market St
9TH Floor
Philadelphia, PA 19104-5545
Phone
(215) 662-8777
NPI assigned
Dec 29, 2014
Organization subpart
No

Authorized official

Name
Chante L Jackson
Title
Emrollment 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 66

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

View all 66

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

700 W Lincoln Hwy
Exton, PA 19341
Phone (610) 431-5131

777 Township Line Rd
Fl 2
Yardley, PA 19067
Phone (215) 860-0775

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RS0010X PA Yes

Addresses

Primary practice location

3737 Market St
9TH Floor
Philadelphia, PA 19104-5545

Mailing address

3737 Market St
9TH Floor
Philadelphia, PA 19104-5545
Phone (215) 662-8777

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 · Sports Medicine (Internal Medicine) Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.