NPIMap

Organization Active NPI

Trinity Health Mid-Atlantic Medical Group

Doing business as Nazareth Health Residency Center

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1497312656
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Doing business as
Nazareth Health Residency Center
Practice address
1407 Rhawn St
Philadelphia, PA 19111-2803
Phone
(267) 957-7027
Fax
(267) 957-7029
NPI assigned
May 23, 2019
Last updated
Mar 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

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

Authorized official

Name
Julie Keese
Title
VP, Finance and Cfo
Phone
(301) 754-7201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

1407 Rhawn St
Philadelphia, PA 19111-2803

Mailing address

41 University Dr Ste 300
Newtown, PA 18940-1873
Phone (734) 343-2654

Other names 1

  • Nazareth Health Residency Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000613 PA Part B Supplier - Clinic/Group Practice 7416861885 Receives reassigned benefits from 703 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Nazareth Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773360000000",
    "number": "1497312656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 UNIVERSITY DR STE 300",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189401873",
            "telephone_number": "734-343-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 RHAWN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112803",
            "telephone_number": "267-957-7027",
            "fax_number": "267-957-7029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A",
        "authorized_official_last_name": "KEESE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP, FINANCE AND CFO",
        "authorized_official_telephone_number": "301-754-7201"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nazareth Health Residency Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.