Active NPI
Michael A. Resnick, D.O.
- Gastroenterology Physician
- Philadelphia, PA
National Provider Identifier
1336170638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- OS003948L
- Practice address
- 9501 Roosevelt Blvd
Suite 103
Philadelphia, PA 19114-1025 - Phone
- (215) 671-9900
- Fax
- (215) 671-9110
- NPI assigned
- Jul 5, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | OS003948L | PA | Primary |
Addresses
Primary practice location
9501 Roosevelt Blvd
Suite 103
Philadelphia, PA 19114-1025
Mailing address
9501 Roosevelt Blvd
Suite 103
Philadelphia, PA 19114-1025
Phone (215) 671-9900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0086025401 | Medicaid | PA |
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 |
|---|---|---|---|---|
| I20050922000245 | PA | Practitioner - Gastroenterology | 5698709392 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336170638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9501 ROOSEVELT BLVD",
"address_2": "SUITE 103",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191141025",
"telephone_number": "215-671-9900",
"fax_number": "215-671-9110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9501 ROOSEVELT BLVD",
"address_2": "SUITE 103",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191141025",
"telephone_number": "215-671-9900",
"fax_number": "215-671-9110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESNICK",
"first_name": "MICHAEL",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "PA",
"license": "OS003948L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0086025401",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.