NPIMap

Individual provider Active NPI

Susan M Domchek, MD

  • Medical Oncology Physician
  • Philadelphia, PA
National Provider Identifier
1487695102
Registry record updated Feb 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
MD417437 Issued in PA
Practice address
3400 Spruce St
15 Penn Tower
Philadelphia, PA 19104
Phone
(215) 662-3914
NPI assigned
Jun 10, 2006
Last updated
Feb 8, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X MD417437 PA Primary

Addresses

Primary practice location

3400 Spruce St
15 Penn Tower
Philadelphia, PA 19104

Mailing address

3400 Spruce St
15 Penn Tower
Philadelphia, PA 19104-4206

Other identifiers 1

IdentifierTypeStateIssuer
0018658450001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040310000015 PA Practitioner - Internal MedicinePractitioner - Medical Oncology 7315835428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Medical Oncology
Education
Harvard Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Philadelphia, PA 19104-5127

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD417437PAMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Medical Oncology CurrentSince Oct 1, 2001 Accepting new patients
University of Penn-Medical Group CurrentSince Oct 1, 2001 Accepting new patients
University of Penn - Medical Group Past Accepting new patients
Bih Radiologic Foundation Inc Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Fl 2W
Berwyn, PA 19312

3400 Civic Center Blvd
#2
Philadelphia, PA 19104
Phone (215) 615-0063

3400 Civic Center Blvd
#3W
Philadelphia, PA 19104
Phone (215) 662-2891

3400 Civic Center Blvd
Fl 3W
Philadelphia, PA 19104

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

3400 Spruce St
#15
Philadelphia, PA 19104
Phone (215) 573-2784

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

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

145 King of Prussia Rd
#200N
Wayne, PA 19087

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297123200000",
    "number": "1487695102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "15 PENN TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "15 PENN TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMCHEK",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2011-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "PA",
            "license": "MD417437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018658450001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.