Active NPI
University of Penn-Neurology Assts.
- Neurology Physician
- Philadelphia, PA
National Provider Identifier
1346359510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- UNIVERSITY OF PENN-NEUROLOGY ASSTS.
- Practice address
- 3400 Spruce St
2 Ravdin
Philadelphia, PA 19104-4206 - Phone
- (215) 662-3606
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth Johnston
- Title
- Executive Director
- Phone
- (215) 662-7583
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | PA | Primary | |
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | PA |
Addresses
Primary practice location
3400 Spruce St
2 Ravdin
Philadelphia, PA 19104-4206
Mailing address
3400 Spruce St
2 Ravdin
Philadelphia, PA 19104-4206
Phone (215) 662-3606
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA1585 | Other | PA | RR MEDICARE |
| 118289600 | Other | PA | ACS |
| 0002Y21675 | Other | PA | HEALTHNET |
| 0055785000 | Other | PA | KEYSTONE |
| 203677 | Other | PA | EEIOC |
| 005023 | Other | PA | AETNA |
| 273304 | Other | PA | MAMSI |
| 1008658 | Other | PA | MERCY |
| 10375 | Other | PA | HEALTHPARTNERS |
| 039188 | Other | PA | BLUE SHIELD |
| 1001258770 | Medicaid | PA | |
| 3578909 | Medicaid | NJ | |
| G00031400 | Other | PA | AMERICHOICE |
National Provider Directory
National Provider DirectoryLocations
330 N 9th St
Philadelphia, PA 19107
Phone (215) 829-6500
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1388966400000",
"number": "1346359510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"address_2": "2 RAVDIN",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-3606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"address_2": "2 RAVDIN",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-3606"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNIVERSITY OF PENN-NEUROLOGY ASSTS.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-30",
"last_updated": "2014-01-06",
"status": "A",
"authorized_official_last_name": "JOHNSTON",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "215-662-7583"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": "PA",
"license": null,
"primary": true
},
{
"code": "2084N0402X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
"state": "PA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CA1585",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACS",
"identifier": "118289600",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "0002Y21675",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE",
"identifier": "0055785000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EEIOC",
"identifier": "203677",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "005023",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "273304",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "1008658",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "10375",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "039188",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1001258770",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3578909",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "G00031400",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-PA Trauma
- University of Penn-Rad Onc
- University of Pennsylvania
- University of Pennsylvania
- University of Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.