NPIMap

Individual provider Active NPI

Marissa A Blum, MD

  • Rheumatology Physician
  • Philadelphia, PA
National Provider Identifier
1316080229
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
MD431822 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-4600
NPI assigned
Feb 14, 2007
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X MD431822 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

3500 N Broad St RM 1Ana
Philadelphia, PA 19140-4106
Phone (215) 707-2433

Other practice location 1

3737 Market St
8th Fl
Philadelphia, PA 19104
Phone (215) 662-4333

Other names 1

  • Marissa A Fankhanel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090731000012 PA Practitioner - Rheumatology 0143373639 Reassigns benefits to 3 organizations
I20210301000280 NJ Practitioner - Rheumatology 0143373639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Johns Hopkins University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3326

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Current Accepting new patients
Temple Physician Inc. CurrentSince Jan 1, 2015 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 25, 2020 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 5, 2019 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Nov 25, 2020 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 25, 2020 Accepting new patients
Temple Physicians Inc CurrentSince Jan 1, 2015 Accepting new patients
Temple Faculty Practice Plan, Inc Rheumatology CurrentSince Mar 5, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 25, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Physicians Inc Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

1865 Route 70 E
Ste 220
Cherry Hill, NJ 08003
Phone (856) 429-0505

350 Forsgate Dr
Ste 103
Monroe Twp, NJ 08831
Phone (609) 831-0779

1006 Mantua Pike
Woodbury Hts, NJ 08097
Phone (856) 845-6880

515 Pennsylvania Ave
Ft Washington, PA 19034
Phone (215) 641-0700

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

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3400 Civic Center Blvd
Fl 1
Philadelphia, PA 19104
Phone (215) 615-5864

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3401 N Broad St
#M
Philadelphia, PA 19140

3500 N Broad St
Rm 1ANA
Philadelphia, PA 19140

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

3737 Market St
Fl 8
Philadelphia, PA 19104
Phone (215) 662-4333

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

Organizations & group practices 12

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 9

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": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1316080229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N BROAD ST RM 1ANA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404106",
            "telephone_number": "215-707-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3737 Market St",
            "address_2": "8th Fl",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-662-4333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUM",
        "first_name": "MARISSA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "PA",
            "license": "MD431822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "FANKHANEL",
            "middle_name": "A",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.