NPIMap

Individual provider Active NPI

Imara R Dissanayake, MD

  • Nephrology Physician
  • Phila, PA
National Provider Identifier
1295796969
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD072898L Issued in PA
Practice address
5501 Old York Rd
Phila, PA 19144
Phone
(215) 456-6970
Fax
(215) 456-7154
NPI assigned
Mar 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD072898L PA Primary

Addresses

Primary practice location

5501 Old York Rd
Phila, PA 19144

Mailing address

101 East Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 456-7000

Other identifiers 1

IdentifierTypeStateIssuer
001866922MedicaidPA

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
I20111230000118 PA Practitioner - Nephrology 4688840374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

3300 Aramingo Ave
Philadelphia, PA 19134-4500
Phone (215) 634-5110

Hospital & facility affiliations

  • DaVita Northern Philadelphia Dialysis Dialysis facility, Philadelphia, PA, CCN 392509
  • DaVita NE Philadelphia Dialysis Center Dialysis facility, Philadelphia, PA, CCN 392555
  • DaVita Wyncote Dialysis Dialysis facility, Wyncote, PA, CCN 392635
  • DaVita Cheltenham Dialysis Dialysis facility, Cheltenham, PA, CCN 392810
  • Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc Current Accepting new patients
Einstein Practice Plan Inc Nephrology CurrentSince Jul 1, 2001 Accepting new patients
Einstein Practice Plan Inc CurrentSince Jul 1, 2001 Accepting new patients

Locations

60 Township Line Rd
Elkins Park, PA 19027
Phone (215) 663-6000

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

5501 York Rd
Philadelphia, PA 19141
Phone (215) 456-7405

101 E Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 254-2630

900 E Howell St
Unit A
Philadelphia, PA 19149
Phone (215) 831-6170

3330 Aramingo Ave
Philadelphia, PA 19134
Phone (215) 427-2242

5401 Old York Rd
Philadelphia, PA 19141
Phone (215) 456-7150

Interoperability endpoints

  • Direct secure messaging: imara.dissanayake1@direct.einstein.edu

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1295796969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 EAST OLNEY AVE",
            "address_2": "STE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19120",
            "telephone_number": "215-456-7000",
            "fax_number": "215-254-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19144",
            "telephone_number": "215-456-6970",
            "fax_number": "215-456-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSANAYAKE",
        "first_name": "IMARA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD072898L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001866922",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

Verify at the official NPI Registry.