NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

  • Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1386632305
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
Temple Neurology Associates
Practice address
3509 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-3040
Fax
(215) 707-8235
NPI assigned
Oct 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Authorized official

Name
Tonya Woodard
Title
Credentialing/Manager
Phone
(215) 707-3911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3509 N Broad St
Philadelphia, PA 19140-5103

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-3040

Other practice location 1

515 Pennsylvania Ave
Fort Washington, PA 19034-3314
Phone (215) 707-3040

Other practice location 2

7600 Central Ave
Philadelphia, PA 19111-2442
Phone (215) 707-3040

Other practice location 3

255 S 17th St
Philadelphia, PA 19103-6231
Phone (215) 875-2200

Other practice location 4

1650 Huntingdon Pike
Meadowbrook, PA 19046-8004
Phone (215) 707-3040

Other identifiers 5

IdentifierTypeStateIssuer
1007780130812MedicaidPA
1007780130808MedicaidPA
1007780130810MedicaidPA
1007780130811MedicaidPA
1007780130809MedicaidPA

Other names 1

  • Temple Neurology Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000333 PA Part B Supplier - Clinic/Group Practice 2961314299 Receives reassigned benefits from 19 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1386632305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7600 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112442",
            "country_code": "US",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "255 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191036231",
            "country_code": "US",
            "telephone_number": "215-875-2200",
            "fax_number": "215-875-9714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Huntingdon Pike",
            "address_purpose": "LOCATION",
            "city": "Meadowbrook",
            "state": "PA",
            "postal_code": "190468004",
            "country_code": "US",
            "telephone_number": "215-707-3040",
            "fax_number": "215-707-8235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130812",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130808",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130810",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130811",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130809",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Neurology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Neurology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.