Individual provider Active NPI

Michelle Cerato Booth, PAC

  • Medical Physician Assistant
  • Media, PA
National Provider Identifier
1417143033
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA001419L Issued in PA
Practice address
53 W Baltimore Pike Ste 100
Media, PA 19063-5641
Phone
(610) 565-2100
Fax
(610) 892-0626
NPI assigned
Sep 18, 2007
Last updated
Apr 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA001419L PA Primary

Addresses

Primary practice location

53 W Baltimore Pike Ste 100
Media, PA 19063-5641

Mailing address

207 N Broad St
3Rd FLR Cardiology Consultants of Phila
Phila, PA 19107
Phone (610) 565-2100

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071012000297 PA Practitioner - Physician Assistant 6204922834 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cardiology Consultants of Philadelphia PCGroup PAC ID 5294620746, 154 clinicians

Practice addresses (Care Compare)

1703 S Broad St
Suite 300
Philadelphia, PA 19148-1536
Phone (215) 463-5333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Jul 29, 2012 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jul 29, 2012 Accepting new patients

Locations

51 N 39th St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-9010

7133 Roosevelt Blvd
Philadelphia, PA 19149
Phone (215) 333-3311

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1417143033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N BROAD ST",
            "address_2": "3RD FLR CARDIOLOGY CONSULTANTS OF PHILA",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "610-565-2100",
            "fax_number": "610-892-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 W BALTIMORE PIKE STE 100",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635641",
            "telephone_number": "610-565-2100",
            "fax_number": "610-892-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERATO BOOTH",
        "first_name": "MICHELLE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-18",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001419L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Media, PA

Sources for this page

Verify at the official NPI Registry.