Active NPI
Pouya Bandegi
- Diagnostic Radiology Physician
- Philadelphia, PA
National Provider Identifier
1326938754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MT233130
- Practice address
- 111 S 11TH St
Philadelphia, PA 19107-4870 - Phone
- (215) 955-6000
- NPI assigned
- Jul 7, 2025
- Last updated
- Jul 7, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MT233130 | PA | Primary |
Addresses
Primary practice location
111 S 11TH St
Philadelphia, PA 19107-4870
Mailing address
943 Lombard St
Philadelphia, PA 19147-1239
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250811002206 | PA | Order and Referring Only - Diagnostic Radiology | 2567960305 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT233130 | PA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751846400000",
"number": "1326938754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "943 LOMBARD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191471239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 S 11TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191074870",
"telephone_number": "215-955-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDEGI",
"first_name": "POUYA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-07",
"last_updated": "2025-07-07",
"certification_date": "2025-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "PA",
"license": "MT233130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.