NPIMap

Organization Active NPI

Trustees of the University of Pennsylvania

  • Community/Retail Pharmacy
  • Philadelphia, PA
National Provider Identifier
1366835910
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP482555 Issued in PA
Legal business name
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Practice address
3400 Civic Center Blvd # 101W
Philadelphia, PA 19104-5127
Phone
(215) 662-6260
Fax
(215) 243-2345
NPI assigned
Mar 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Richard Demers
Title
Director of Pharmacy
Phone
(215) 662-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PP482555 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd # 101W
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd # 101W
Philadelphia, PA 19104-5127
Phone (215) 662-6260

Other identifiers 2

IdentifierTypeStateIssuer
100125877MedicaidPA
2150466OtherPK

Other names 1

  • Hospital of the University of Pennsylvania-Perelman Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151105002164 PA Part B Supplier - Mass Immunization (Roster Biller Only) 2062326507 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Radnor, PA
O20160323002009 PA DME Supplier - Pharmacy 2062326507 Practice locations: Philadelphia, PA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Univ of Penn Dept of NE44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

3400 Civic Center Blvd
#101W
Philadelphia, PA 19104
Phone (215) 662-6260

145 King of Prussia Rd
Ste 109N
Wayne, PA 19087
Phone (610) 902-1700

Ownership & related parties

All facility ownership & control disclosures 17

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Penn Medicine Princeton Medical CenterPlainsboro, NJ, CCN 310010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Lancaster General HospitalLancaster, PA, CCN 390100 Hospital 5% Or Greater Indirect Ownership Interest Aug 1, 2015
Hospital of the University of PennsylvaniaPhiladelphia, PA, CCN 390111 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 18, 2007
Oct 18, 2007
Hospital of the University of PennsylvaniaPhiladelphia, PA, CCN 39T111 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 16, 2007
Nov 16, 2017
The Pennsylvania Hospital of the University of Pennsylvania Health SysPhiladelphia, PA, CCN 390226 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 30, 1997
The Pennsylvania Hospital of the University of Pennsylvania Health SysPhiladelphia, PA, CCN 39S226 Hospital 5% Or Greater Direct Ownership Interest Apr 30, 1997
Penn Presbyterian Medical CenterPhiladelphia, PA, CCN 390223 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 13, 1995
Penn Medicine | Good Shepherd RehabilitationPhiladelphia, PA, CCN 392050 Hospital Other (49%) Jul 1, 2019
Chester County HospitalWest Chester, PA, CCN 390179 Hospital 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2013
Penn Medicine Princeton Medical Center Acute Rehabilitation CenterPlainsboro, NJ, CCN 31T010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine Princeton House Behavioral HealthPlainsboro, NJ, CCN 31S010 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Lancaster Behavioral Health HospitalLancaster, PA, CCN 394055 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 7, 2014
Rittenhouse Post AcutePhiladelphia, PA, CCN 395749 Skilled nursing facility Adp of the SNF Sep 12, 2024
Penn Medicine Home HealthBala Cynwyd, PA, CCN 397125 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jun 13, 1995
Penn Medicine Home Health Princeton HealthPrinceton, NJ, CCN 317045 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine Hospice Princeton HealthPrinceton, NJ, CCN 311506 Hospice 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2018
Penn Medicine HospiceBala Cynwyd, PA, CCN 391501 Hospice 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1997

Owned or controlled facilities with NPI records 20

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 20

Practitioners & affiliated clinicians

Practitioners 150

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 150

NPI Registry JSON

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

{
    "created_epoch": "1425600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1366835910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD # 101W",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-6260",
            "fax_number": "215-243-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD # 101W",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-6260",
            "fax_number": "215-243-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-06",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "DEMERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "215-662-2900"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100125877",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150466",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospital of the University of Pennsylvania-Perelman Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.