NPIMap

Organization Active NPI

The Pennsylvania Hospital of the University of Pennsylvania Health Sys

  • Psychiatric Hospital Unit
  • Phila, PA
National Provider Identifier
1306814348
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS
Practice address
800 Spruce St
Phila, PA 19107-6130
Phone
(215) 796-4640
Fax
(215) 762-0754
NPI assigned
Mar 8, 2006
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Mr. Thomas McCormick Jr.
Title
Avp Finance
Phone
(215) 762-0888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

800 Spruce St
Phila, PA 19107-6130

Mailing address

1500 Market St
Upper Mezenine 600
Philadelphia, PA 19102-2100
Phone (215) 796-4640

Other identifiers 1

IdentifierTypeStateIssuer
1000049150005MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080117000330 PA Part A Provider - Hospital 6305927229 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306814348. Details of each certification follow.

Hospital certification: CCN 39S226

Legal name
THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 1997 in PA
Enrollment address
800 Spruce St
Philadelphia, PA 19107-6130
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pennsylvania Hospital of the University of Pennsylvania Health System14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Julia Puchtler Individual Corporate Director Jul 1, 2024
Allen Herbert Bar Individual Corporate Director Jun 11, 2008
Trustees of the University of Pennsylvania Organization, Philadelphia, PA Non-profit 5% Or Greater Direct Ownership Interest Apr 30, 1997
Michele Volpe Individual Corporate DirectorBoard Member Sep 1, 2022
Kevin B Mahoney Individual Corporate Director Jun 6, 2006
Thomas Sharbaugh Individual Corporate Director May 4, 2001
Kathy Killian Individual Corporate DirectorBoard Member Jan 1, 2022
Alicia Gresham Individual Corporate OfficerCeo Jan 2, 2024
Corporate DirectorCeo Jan 2, 2024
Melissa L Zak Individual Corporate DirectorBoard Member Jun 8, 2023
Jill Roberts Individual Corporate DirectorBoard Member Jan 1, 2022
Theresa Larivee Individual Corporate Director Nov 1, 2014
The Pennsylvania Hospital of the University of Pennsylvania Health Sys Organization, Philadelphia, PA Operational/Managerial Control Apr 30, 1997
Thomas McCormick Individual W-2 Managing Employee Jun 28, 2001
Michael Rossi Individual W-2 Managing Employee Oct 1, 2006
Lindsay Ayling Individual Corporate OfficerChief Financial Officer Dec 28, 2023
W-2 Managing EmployeeChief Financial Officer Dec 28, 2023

Owners & managing parties with NPI records 16

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 16

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Pennsylvania Hospital of the University of Pennsylvania Health SysPhiladelphia, PA, CCN 390226 Hospital Operational/Managerial Control Apr 30, 1997

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 14

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 14

Practitioners & affiliated clinicians

Practitioners 4

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": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1306814348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MARKET ST",
            "address_2": "UPPER MEZENINE 600",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022100",
            "telephone_number": "215-796-4640",
            "fax_number": "215-762-0754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SPRUCE ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191076130",
            "telephone_number": "215-796-4640",
            "fax_number": "215-762-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "AVP FINANCE",
        "authorized_official_telephone_number": "215-762-0888",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000049150005",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

Verify at the official NPI Registry.