Individual provider Active NPI

Michael Pack, MD

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1477567162
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD034667E Issued in PA
Practice address
3400 Spruce Street
3 Dulles Building
Philadelphia, PA 19104-4206
Phone
(215) 349-8222
Fax
(215) 662-6530
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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 MD034667E PA
Gastroenterology Physician 207RG0100X MD034667E PA Primary

Addresses

Primary practice location

3400 Spruce Street
3 Dulles Building
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce Street
3 Dulles Building
Philadelphia, PA 19104-4206
Phone (215) 349-8222

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
I20100317000336 PA Practitioner - GastroenterologyPractitioner - Internal Medicine 7618002585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

501 S 54TH St
Philadelphia, PA 19143-1900
Phone (215) 349-8222

51 N 39TH St 218 WS
Gastro PPMC
Philadelphia, PA 19104-2640
Phone (215) 662-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy39
Upper gastrointestinal (GI) endoscopy for acid reflux77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD034667EPAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jan 29, 1997 Accepting new patients
University of Penn - Medical Group Gastroenterology CurrentSince Jan 29, 1997 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3400 Spruce St
Rm 1212
Philadelphia, PA 19104

230 W Washington Sq
Fl 4
Philadelphia, PA 19106
Phone (215) 829-3561

3400 Spruce St
Fl 3
Philadelphia, PA 19104

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

3400 Civic Center Blvd
Fl 4
Philadelphia, PA 19104
Phone (215) 662-3580

3737 Market St
Fl 11
Philadelphia, PA 19104
Phone (215) 662-8900

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

145 King of Prussia Rd
Ste 205
Wayne, PA 19087
Phone (610) 902-4858

Organizations & group practices 3

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 4

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1477567162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 DULLES BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-349-8222",
            "fax_number": "215-662-6530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 DULLES BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-349-8222",
            "fax_number": "215-662-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD034667E",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD034667E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.