Individual provider Active NPI

John P. Simelaro, DO

  • Pulmonary Disease Physician
  • Philadelphia, PA
National Provider Identifier
1477554541
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
OS002871L Issued in PA
Practice address
4190 City Ave
Suite 315
Philadelphia, PA 19131-1626
Phone
(215) 871-6337
Fax
(215) 871-6347
NPI assigned
Aug 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS002871L PA
Pulmonary Disease Physician 207RP1001X OS002871L PA Primary

Addresses

Primary practice location

4190 City Ave
Suite 315
Philadelphia, PA 19131-1626

Mailing address

4190 City Ave
Suite 315
Philadelphia, PA 19131-1626
Phone (215) 871-6337

Other identifiers 1

IdentifierTypeStateIssuer
000701801MedicaidPA

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
I20190715000051 PA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4981794062

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Management of Southeastern Pennsylvania Past Accepting new patients
Methodist Associates in Healthcare, Inc Internal Medicine Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1477554541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 CITY AVE",
            "address_2": "SUITE 315",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311626",
            "telephone_number": "215-871-6337",
            "fax_number": "215-871-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 CITY AVE",
            "address_2": "SUITE 315",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311626",
            "telephone_number": "215-871-6337",
            "fax_number": "215-871-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMELARO",
        "first_name": "JOHN",
        "middle_name": "P.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS002871L",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "OS002871L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000701801",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.