Dedicated Pennsylvania Holding, LLC
Organization Active NPI Specialist · Philadelphia, PA
NPI 1477053569 · NPPES record last updated Mar 27, 2018
Key facts
- NPI
- 1477053569
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- DEDICATED PENNSYLVANIA HOLDING, LLC
- Practice address
- 6431 Sackett St
Philadelphia, PA 19149-3118 - Phone
- (305) 628-6117
- Fax
- (305) 363-5989
- NPI assigned
- Feb 15, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- DEDICATED PENNSYLVANIA MAYFAIR
Authorized official
- Name
- Mr. Raymond Jimenez
- Title
- Director of Client Services
- Phone
- (786) 870-4039
Other NPIs on the same Medicare enrollment 4
Practitioners 66
-
Lisa Abdul-Haqq, CRNP
-
David Barr, M.D.
-
Akilah Bates, M.D.
-
Naiema A Benson, D.O.
-
Ellen H Kim, MD
-
Sumit Kumar, M.D.
-
Anup Patel, DO
-
Robert Thomas Perkins, D.O.
-
Poonguzhali Pichaimuthu, M.D.
-
Caroline Rogi, MD
-
Waqas Salam, DO
-
Mahmud Ali, M.D.
-
Yao-Chieh Cheng, MD
-
Victoria Cimino, MD MPH
-
Darrin Eric Doran, D.O.
-
Ephraim Dunn, D. O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180308000694 | PA | Part B Supplier - Clinic/Group Practice | 4688935653 |
Receives reassigned benefits from 63 practitioners 4 other NPIs on this enrollment Practice locations: Philadelphia, PA |
National Provider Directory
- Part of
- Dedicated PA Holding LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Primary Care Clinic/Center | 261QP2300X | |||
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
6431 Sackett St
Philadelphia, PA 19149-3118
Mailing address
1395 N.W/ 167TH Street
Payer Enrollment Department
Miami Gardens, FL 33169
Phone (786) 870-4039
Other names
- Dedicated Pennsylvania Mayfair
Other providers in Philadelphia, PA
- Raj Champak Dedhia
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- Dedicated Hands 4 U LLC
- Dedicated Pennsylvania Holding, LLC
- Dedicated Pennsylvania Holding, LLC
- Dedicated Pennsylvania Holding, LLC
- Dedicated Pennsylvania Holding, LLC
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- Dedicated Tender Care LLC
- Dedicating Time-You Matter
All providers in Philadelphia, PA · Specialist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.