Individual provider Active NPI

Deepak Mavahalli Sampathu, MD

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1326246711
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD447827 Issued in PA
Practice address
3400 Spruce St
1 Silverstein
Philadelphia, PA 19104
Phone
(215) 662-3000
NPI assigned
Jul 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X MD447827 PA
Diagnostic Radiology Physician 2085R0202X MD447827 PA Primary

Addresses

Primary practice location

3400 Spruce St
1 Silverstein
Philadelphia, PA 19104

Mailing address

3400 Spruce St
1 Silverstein
Philadelphia, PA 19104
Phone (215) 662-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 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
I20130718000046 PA Practitioner - Diagnostic Radiology 9830339720 Reassigns benefits to 1 organization
I20161122001249 NJ Practitioner - Diagnostic Radiology 9830339720 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Perelman School of Med at the University of Pennsylvania, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinical Health Care Associates of New Jersey PCGroup PAC ID 0749180198, shared by 7 NPIs, 793 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1006 Mantua Pike
Woodbury, NJ 08097-1221
Phone (856) 686-8282

1865 Route 70 E 130
Rad Cherry Hill
Cherry Hill, NJ 08003-2013
Phone (856) 433-2535

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3000

Hospital & facility affiliations

  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
  • Chester County Hospital Hospital, West Chester, PA, CCN 390179

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD447827PAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Health Care Associates of New Jersey, PC Current Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Oct 15, 2016 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group Neuroradiology CurrentSince May 1, 2015 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Sep 9, 2017 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. Diagnostic Radiology CurrentSince Oct 15, 2016 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients

Locations

1865 Route 70 E
Ste 130
Cherry Hill, NJ 08003
Phone (856) 433-2535

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

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

250 W Lancaster Ave
Ste 180
Paoli, PA 19301
Phone (610) 644-0477

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

3400 Spruce St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-3005

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

Organizations & group practices 7

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": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1326246711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "1 SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "1 SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPATHU",
        "first_name": "DEEPAK",
        "middle_name": "MAVAHALLI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-06",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "PA",
            "license": "MD447827",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD447827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.