NPIMap

Organization Active NPI

Children's Hospital of Philadelphia

Doing business as CHOP Primary Care Souderton

  • Pediatrics Physician
  • Souderton, PA
National Provider Identifier
1386727923
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDREN'S HOSPITAL OF PHILADELPHIA
Doing business as
CHOP Primary Care Souderton
Practice address
4 S County Line Rd
Souderton, PA 18964-2814
Phone
(215) 723-7177
Fax
(215) 721-8771
NPI assigned
Oct 24, 2006
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S HOSPITAL OF PHILADELPHIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Fabian Stone
Title
VP Revenue Cycle
Phone
(267) 425-5765

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X PA Primary

Addresses

Primary practice location

4 S County Line Rd
Souderton, PA 18964-2814

Mailing address

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Other identifiers 1

IdentifierTypeStateIssuer
1007709910022MedicaidPA

Other names 1

  • CHOP Primary Care Souderton Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0194227Chop Primary Care - Souderton4 S County Line Road, Souderton, PA 18964Certificate of waiverMay 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
The Children's Hospital of Philadelphia70 organizations share this tax ID, including this one
Part of
The Children's Hospital of Philadelphia

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3456 Bethlehem Pike
Fl 2
Souderton, PA 18964
Phone (215) 453-0560

440 E Marshall St
Ste 300
West Chester, PA 19380
Phone (610) 436-8611

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1386727923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 S COUNTY LINE RD",
            "city": "SOUDERTON",
            "state": "PA",
            "postal_code": "189642814",
            "telephone_number": "215-723-7177",
            "fax_number": "215-721-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
        "enumeration_date": "2006-10-24",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "FABIAN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "267-425-5765"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007709910022",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHOP Primary Care Souderton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Souderton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.