NPIMap

Individual provider Active NPI

Kendall Alexander Cliatt

  • Family Medicine Physician
  • East Norriton, PA
National Provider Identifier
1407483266
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS022851 Issued in PA
Practice address
2705 Dekalb Pike # 202
East Norriton, PA 19401-1852
Phone
(610) 275-7240
Fax
(610) 275-0633
NPI assigned
Mar 23, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X OS022851 PA Primary

Addresses

Primary practice location

2705 Dekalb Pike # 202
East Norriton, PA 19401-1852

Mailing address

2705 Dekalb Pike # 202
East Norriton, PA 19401-1852
Phone (610) 275-7240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230811000060 PA Practitioner - Family Practice 8022428911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Penn Medicine-PmaGroup PAC ID 6507269370, 55 clinicians

Practice addresses (Care Compare)

9 N Brookside Rd
Springfield, PA 19064-2527
Phone (610) 543-5400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS022851PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penn Medicine-Pma CurrentSince Jul 10, 2023 Accepting new patients
Penn Medicine-Pma CurrentSince Jul 10, 2023 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Family Medicine Past Accepting new patients

Locations

150 Monument Rd
Ste 400
Bala Cynwyd, PA 19004
Phone (610) 747-3470

9 N Brookside Rd
Springfield, PA 19064
Phone (610) 543-5300

Interoperability endpoints

  • FHIR API: https://ssproxy.pennhealth.com/PRD-FHIR/api/FHIR/R4/

Organizations & group practices 3

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 7

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": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1407483266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 DEKALB PIKE # 202",
            "city": "EAST NORRITON",
            "state": "PA",
            "postal_code": "194011852",
            "telephone_number": "610-275-7240",
            "fax_number": "610-275-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 DEKALB PIKE # 202",
            "city": "EAST NORRITON",
            "state": "PA",
            "postal_code": "194011852",
            "telephone_number": "610-275-7240",
            "fax_number": "610-275-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLIATT",
        "first_name": "KENDALL",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS022851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Norriton, PA

Sources for this page

Verify at the official NPI Registry.