Individual provider Active NPI

Luis H. Eraso, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1366487340
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD434112 Issued in PA
Practice address
111 S 11TH St
Suite 6270
Philadelphia, PA 19107-4824
Phone
(215) 955-4901
Fax
(215) 923-0835
NPI assigned
Jun 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD434112 PA Primary

Addresses

Primary practice location

111 S 11TH St
Suite 6270
Philadelphia, PA 19107-4824

Mailing address

111 S 11TH St
Suite 6270
Philadelphia, PA 19107-4824

Other identifiers 2

IdentifierTypeStateIssuer
0267414MedicaidNJ
102612347MedicaidPA

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
I20110824000593 PA Practitioner - Internal Medicine 1254356876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Philadelphia, PA 19107-4824
Phone (215) 955-6540

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
  • Magee Rehabilitation Hospital Inpatient rehabilitation facility, Philadelphia, PA, CCN 393038

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Internal Medicine CurrentSince Jul 11, 2011 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

111 S 11th St
Ste 6270
Philadelphia, PA 19107
Phone (215) 955-6540

1300 Wolf St
Philadelphia, PA 19148
Phone (215) 952-1428

1300 Wolf St
Fl 1
Philadelphia, PA 19148
Phone (215) 551-0360

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

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

Organizations & group practices 2

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 2

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1366487340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 6270",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 6270",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-4901",
            "fax_number": "215-923-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERASO",
        "first_name": "LUIS",
        "middle_name": "H.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD434112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0267414",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102612347",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.