Individual provider Active NPI

Brandy Scombordi-Raghu, OPTOMETRIST

  • Pediatric Optometrist
  • Philadelphia, PA
National Provider Identifier
1336159268
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric OptometristTaxonomy code 152WP0200X
License
OEG000420 Issued in PA
Practice address
1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone
(215) 276-6000
Fax
(215) 276-1329
NPI assigned
Aug 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Optometrist 152WP0200X OEG000420 PA Primary

Addresses

Primary practice location

1200 W Godfrey Ave
Philadelphia, PA 19141-3323

Mailing address

33 Oswin Turn
Langhorne, PA 19047-2054
Phone (215) 572-0210

Other identifiers 3

IdentifierTypeStateIssuer
2248OtherPAAETNA HMO
2299722000OtherPAKEYSTONE EAST
1622822OtherPABLUE SHIELD

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100112000652 PA Practitioner - Optometry 4385785302 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Drexel UniversityGroup PAC ID 5496664740, 80 clinicians

Practice addresses (Care Compare)

1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone (215) 276-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG000420PAMDPediatric Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Salus University Hearing Vision Balance Clinic CurrentSince Oct 24, 2009 Accepting new patients
Drexel University Current Accepting new patients
Drexel University CurrentSince Dec 28, 2024 Accepting new patients
Drexel University CurrentSince Oct 24, 2009 Accepting new patients
Delaware Valley Community Health, Inc. CurrentSince Mar 22, 2018 Accepting new patients
Drexel University CurrentSince Dec 28, 2024 Accepting new patients
Delaware Valley Community Health, Inc. CurrentSince Mar 22, 2018 Accepting new patients
Pennsylvania College of Optometry Past Accepting new patients

Locations

1427 Vine St
Fl 8
Philadelphia, PA 19102
Phone (215) 762-6660

1427 Vine St
Fl 2
Philadelphia, PA 19102
Phone (215) 762-2530

7630 Germantown Ave
Ste 4
Philadelphia, PA 19118
Phone (215) 276-6000

1412 Fairmount Ave
Philadelphia, PA 19130
Phone (215) 235-9600

1200 W Godfrey Ave
Philadelphia, PA 19141
Phone (215) 276-6000

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: brandy.scombordiraghu.p1@direct.salusuhealth.nextgenshare.com

Organizations & group practices 8

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1336159268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 OSWIN TURN",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190472054",
            "telephone_number": "215-572-0210",
            "fax_number": "215-276-1329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-1329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOMBORDI-RAGHU",
        "first_name": "BRANDY",
        "name_prefix": "Dr.",
        "credential": "OPTOMETRIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "PA",
            "license": "OEG000420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2248",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE EAST",
            "identifier": "2299722000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1622822",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.