NPIMap

Organization Active NPI

Integrated Wound Care Pennsylvania PLLC

  • General Practice Physician
  • Philadelphia, PA
National Provider Identifier
1447722863
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED WOUND CARE PENNSYLVANIA PLLC
Practice address
4400 W Girard Ave
Philadelphia, PA 19104-1002
Phone
(718) 705-6010
NPI assigned
Dec 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Dr. Diane Lusa, MD
Title
President
Phone
(718) 705-6010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4400 W Girard Ave
Philadelphia, PA 19104-1002

Mailing address

492C Cedar LN Ste 514
Teaneck, NJ 07666-1713
Phone (718) 705-6010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190327002946 PA Part B Supplier - Clinic/Group Practice 5294075362 Receives reassigned benefits from 32 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

3350 Riverwood Pkwy SE
Ste 1400
Atlanta, GA 30339

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1545609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1447722863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492C CEDAR LN STE 514",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661713",
            "telephone_number": "718-705-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191041002",
            "telephone_number": "718-705-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WOUND CARE PENNSYLVANIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-24",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "LUSA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-705-6010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 23, 2022; 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.