Individual provider Active NPI

Kristin L. Desimone, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1477586501
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-067102-L Issued in PA
Practice address
833 Chestnut St
Suite 301
Philadelphia, PA 19107-4414
Phone
(215) 955-7190
Fax
(215) 923-9186
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD-067102-L PA Primary
Obstetrics & Gynecology Physician 207V00000X MD-067102-L PA

Addresses

Primary practice location

833 Chestnut St
Suite 301
Philadelphia, PA 19107-4414

Mailing address

833 Chestnut St
Suite 301
Philadelphia, PA 19107-4414

Other identifiers 2

IdentifierTypeStateIssuer
001811245MedicaidPA
0054232MedicaidNJ

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
I20050114000509 PA Practitioner - Family Practice 9830148089 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-067102-LPAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Oct 6, 1998 Accepting new patients
Jefferson University Physicians Family Medicine CurrentSince Oct 6, 1998 Accepting new patients
Jefferson Medical Care, PC Family Medicine PastSince Jun 8, 1992 Accepting new patients

Locations

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1100 Walnut St
Fl 5
Philadelphia, PA 19107
Phone (215) 955-6750

833 Chestnut St
Ste 301
Philadelphia, PA 19107
Phone (215) 955-2363

909 Walnut St
Ste 300
Philadelphia, PA 19107
Phone (215) 955-6215

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1477586501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST",
            "address_2": "SUITE 301",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST",
            "address_2": "SUITE 301",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074414",
            "telephone_number": "215-955-7190",
            "fax_number": "215-923-9186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIMONE",
        "first_name": "KRISTIN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD-067102-L",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD-067102-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001811245",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054232",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.