NPIMap

Organization Active NPI

Avellina Inc.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1285805507
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
AVELLINA INC.
Practice address
2375 Woodward St
Philadelphia, PA 19115-5120
Phone
(215) 676-9223
NPI assigned
Mar 14, 2008
Last updated
Mar 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Authorized official

Name
Violetta Berdichevskaya, M.D.NPI 1104882646
Title
Owner
Phone
(215) 938-1353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

2375 Woodward St
Philadelphia, PA 19115-5120

Mailing address

PO Box 1628
Horsham, PA 19044-6628
Phone (215) 830-9991

Other identifiers 2

IdentifierTypeStateIssuer
001642076OtherPABLUESHIELD
0019378550006MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080612000238 PA Part B Supplier - Clinic/Group Practice 4385715788 Receives reassigned benefits from 10 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Tax ID family
Avellina2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1285805507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1628",
            "city": "HORSHAM",
            "state": "PA",
            "postal_code": "190446628",
            "telephone_number": "215-830-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 WOODWARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191155120",
            "telephone_number": "215-676-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVELLINA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "BERDICHEVSKAYA",
        "authorized_official_first_name": "VIOLETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-938-1353",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "001642076",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019378550006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.