Individual provider Active NPI

Jesse Michael Civan, MD

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1316000805
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD436852 Issued in PA
Practice address
1101 Chestnut St
Philadelphia, PA 19107-3612
Phone
(215) 955-8900
Fax
(215) 955-5245
NPI assigned
Dec 18, 2006
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD436852 PA Primary

Addresses

Primary practice location

1101 Chestnut St
Philadelphia, PA 19107-3612

Mailing address

132 South 10TH Street
480 Main Building
Philadelphia, PA 19107
Phone (215) 955-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, DE2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130628000488 PA Practitioner - Gastroenterology 1456591221 Reassigns benefits to 1 organization
I20140807002127 DE Practitioner - Gastroenterology 1456591221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Perelman School of Med at the University of Pennsylvania, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, shared by 2 NPIs, 1,528 clinicians

Practice addresses (Care Compare)

1300 Wolf St
Philadelphia, PA 19148-2912
Phone (215) 952-1428

4735 Ogletown Stanton Rd
Newark, DE 19713-2072
Phone (215) 955-8900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy38
Upper gastrointestinal (GI) endoscopy for acid reflux31

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Gastroenterology CurrentSince Aug 1, 2015 Accepting new patients
Jefferson University Physicians CurrentSince Aug 1, 2015 Accepting new patients
Jefferson University Physicians Gastroenterology Past Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients

Locations

3521 Silverside Rd
Ste 1L
Wilmington, DE 19810
Phone (302) 477-1991

1101 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-4226

1300 Wolf St
Philadelphia, PA 19148
Phone (215) 952-9500

132 S 10th St
#480
Philadelphia, PA 19107
Phone (215) 955-3947

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 4

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 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": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1316000805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 SOUTH 10TH STREET",
            "address_2": "480 MAIN BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-955-8900",
            "fax_number": "215-955-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073612",
            "telephone_number": "215-955-8900",
            "fax_number": "215-955-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVAN",
        "first_name": "JESSE",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD436852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.