Individual provider Active NPI

Michael Jen, DO

  • Hospitalist Physician
  • Wynnewood, PA
National Provider Identifier
1457913873
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
OS022163 Issued in PA
Practice address
255 W. Lancaster Avenue
Wynnewood, PA 19096
Phone
(484) 565-1510
NPI assigned
Jul 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS022163 PA
Student in an Organized Health Care Education/Training Program 390200000X OT019373 PA
Hospitalist Physician 208M00000X OS022163 PA Primary

Addresses

Primary practice location

255 W. Lancaster Avenue
Wynnewood, PA 19096

Mailing address

255 W. Lancaster Avenue
Wynnewood, PA 19096
Phone (484) 565-1510

Other practice location 1

1500 Lansdowne Ave
Darby, PA 19023-1200
Phone (610) 237-4000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220622000168 PA Practitioner - HospitalistPractitioner - Internal Medicine 8426437484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

255 W Lancaster Ave
Paoli, PA 19301-1763
Phone (484) 337-4097

Hospital & facility affiliations

  • Main Line Health Homecare & Hospice - Hospice Hospice, Radnor, PA, CCN 391583
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT019373PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Main Line Hospitals, Inc. Past Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

255 W Lancaster Ave
Paoli, PA 19301
Phone (484) 337-4286

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

Organizations & group practices 2

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 3

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": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1457913873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W. LANCASTER AVENUE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "484-565-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W. LANCASTER AVENUE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "484-565-1510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Lansdowne Ave",
            "address_purpose": "LOCATION",
            "city": "Darby",
            "state": "PA",
            "postal_code": "190231200",
            "country_code": "US",
            "telephone_number": "610-237-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEN",
        "first_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-05",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS022163",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT019373",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "OS022163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.