NPIMap

Individual provider Active NPI

Jordan O Booty, MD

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1336384189
Registry record updated May 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD451981 Issued in PA
Practice address
3400 Spruce St
1 Silverstein
Philadelphia, PA 19104
Phone
(215) 662-3000
NPI assigned
Dec 9, 2008
Last updated
May 30, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD451981 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
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140702001501 PA Practitioner - Diagnostic Radiology 3779708912 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Jefferson Medical College of Thomas Jefferson University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line Health Imaging LPGroup PAC ID 7618867664, 51 clinicians
Radiology Associates of the Main Line P CGroup PAC ID 9931097193, 80 clinicians

Practice addresses (Care Compare)

255 W Lancaster Ave
Paoli, PA 19301-1763
Phone (484) 565-8068

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
Main Line Health Imaging LP Diagnostic Radiology CurrentSince Oct 1, 2021 Accepting new patients
University of Penn - Medical Group CurrentSince May 1, 2015 Accepting new patients
Radiology Associates of the Main Line P C Diagnostic Radiology CurrentSince Oct 1, 2021 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients
Main Line Health Imaging LP PastSince Oct 1, 2021 Accepting new patients

Locations

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

101 S Bryn Mawr Ave
Bryn Mawr, PA 19010
Phone (610) 526-2200

130 S Bryn Mawr Ave
Bryn Mawr, PA 19010
Phone (484) 337-3000

120 Valley Green Ln
Kng of Prussa, PA 19406
Phone (610) 526-3000

255 W Lancaster Ave
Paoli, PA 19301
Phone (484) 337-4286

255 W Lancaster Ave
Ste 131
Paoli, PA 19301
Phone (610) 560-8060

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

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

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

250 King of Prussia Rd
Ste 3
Radnor, PA 19087
Phone (610) 902-1800

420 W Linfield Trappe Rd
Royersford, PA 19468
Phone (610) 279-8686

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401408000000",
    "number": "1336384189",
    "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": "BOOTY",
        "first_name": "JORDAN",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-09",
        "last_updated": "2014-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD451981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.