NPIMap

Individual provider Active NPI

Mitchell Jason Marder, D.O.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1285673319
Registry record updated Dec 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009943L Issued in PA
Practice address
9331 Old Bustleton Ave
Suite 101
Philadelphia, PA 19115-4204
Phone
(215) 673-1520
Fax
(215) 673-1980
NPI assigned
Jun 5, 2006
Last updated
Dec 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2013

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 OS009943L PA Primary

Addresses

Primary practice location

9331 Old Bustleton Ave
Suite 101
Philadelphia, PA 19115-4204

Mailing address

PO Box 820933
Philadelphia, PA 19182-0933
Phone (215) 673-1520

Other identifiers 1

IdentifierTypeStateIssuer
001803010MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000057 PA Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 7416918529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
Philadelphia College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Temple Physicians IncGroup PAC ID 2062317233, 154 clinicians

Practice addresses (Care Compare)

515 Pennsylvania Ave
Fort Washington, PA 19034-3314
Phone (215) 926-3535

9331 Old Bustleton Ave
Philadelphia, PA 19115-4204

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Physicians Inc CurrentSince Jan 1, 2010 Accepting new patients
Temple Physician Inc. CurrentSince Jan 1, 2010 Accepting new patients
Temple Physicians Inc Family Medicine Current Accepting new patients
Temple Physicians Inc. Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Temple Physicians Inc Family Medicine Past Accepting new patients

Locations

515 Pennsylvania Ave
Fl 2
Ft Washington, PA 19034
Phone (215) 540-0120

9331 Old Bustleton Ave
Ste 101
Philadelphia, PA 19115
Phone (215) 673-1520

Organizations & group practices 6

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387152000000",
    "number": "1285673319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820933",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191820933",
            "telephone_number": "215-673-1520",
            "fax_number": "215-673-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9331 OLD BUSTLETON AVE",
            "address_2": "SUITE 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191154204",
            "telephone_number": "215-673-1520",
            "fax_number": "215-673-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDER",
        "first_name": "MITCHELL",
        "middle_name": "JASON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2013-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009943L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001803010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.