Individual provider Active NPI

Brian D Fedgchin, MD

  • Cardiovascular Disease Physician
  • Phila, PA
National Provider Identifier
1336124221
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD072666L Issued in PA
Practice address
2422 S Broad St
1St Floor
Phila, PA 19145-4418
Phone
(215) 389-1748
Fax
(215) 389-0604
NPI assigned
Dec 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 25MA07513800 NJ
Cardiovascular Disease Physician 207RC0000X MD072666L PA Primary

Addresses

Primary practice location

2422 S Broad St
1St Floor
Phila, PA 19145-4418

Mailing address

2422 S Broad St
1St Floor
Phila, PA 19145-4418
Phone (215) 389-1748

Other practice location 1

3 Crescent Dr Fl 4
Philadelphia, PA 19112-1016
Phone (215) 503-3300

Other identifiers 1

IdentifierTypeStateIssuer
0018594810005MedicaidPA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050725000097 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Nuclear Medicine 9537196340 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine, Nuclear Medicine
Education
Georgetown University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1101 Chestnut St
Philadelphia, PA 19107-3619
Phone (800) 533-3669

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone (215) 955-6161

2301 S Broad St
Philadelphia, PA 19148-3542

3 Crescent Dr
Philadelphia, PA 19112-1016

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07513800NJMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc CurrentSince Jun 1, 2023 Accepting new patients
Jefferson University Physicians CurrentSince Dec 3, 2013 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Aria Health Physician Services Past Accepting new patients
Cardiovascular Associates of the Delaware Valley,P a Cardiovascular Disease PastSince Sep 1, 2023 Accepting new patients

Locations

443 Laurel Oak Rd
Ste 100
Voorhees, NJ 08043
Phone (215) 955-5050

443 Laurel Oak Rd
Voorhees, NJ 08043
Phone (215) 456-4985

1200 York Rd
Abington, PA 19001
Phone (215) 481-2222

111 S 11th St
Ste 8490
Philadelphia, PA 19107
Phone (215) 955-6161

1101 Chestnut St
Fl 9
Philadelphia, PA 19107
Phone (215) 503-1807

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

3998 Red Lion Rd
Philadelphia, PA 19114
Phone (215) 612-4060

3 Crescent Dr
#4
Philadelphia, PA 19112

2422 S Broad St
#1
Philadelphia, PA 19145
Phone (215) 389-0600

1015 Chestnut St
Ste 1400
Philadelphia, PA 19107
Phone (215) 955-2920

2301 S Broad St
Philadelphia, PA 19148
Phone (215) 952-9000

Organizations & group practices 5

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 1

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": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1336124221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 S BROAD ST",
            "address_2": "1ST FLOOR",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191454418",
            "telephone_number": "215-389-1748",
            "fax_number": "215-389-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 S BROAD ST",
            "address_2": "1ST FLOOR",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191454418",
            "telephone_number": "215-389-1748",
            "fax_number": "215-389-0604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Crescent Dr Fl 4",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191121016",
            "country_code": "US",
            "telephone_number": "215-503-3300",
            "fax_number": "215-503-3321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDGCHIN",
        "first_name": "BRIAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA07513800",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD072666L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018594810005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

Verify at the official NPI Registry.