Individual provider Active NPI

Symphorien Andre Kamanou, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1508529918
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP024118 Issued in PA
Practice address
8001 State Rd
Philadelphia, PA 19136-2908
Phone
(215) 685-8215
NPI assigned
Oct 21, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP024118 PA Primary

Addresses

Primary practice location

8001 State Rd
Philadelphia, PA 19136-2908

Mailing address

26 Edgemont Ave
Clifton Heights, PA 19018-1726
Phone (484) 477-7493

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221128002778 PA Practitioner - Nurse Practitioner 1052789880 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
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
Psychiatry Hup Cedar
Philadelphia, PA 19143-1900
Phone (215) 748-9000

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP024118PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Dec 25, 2022 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Dec 25, 2022 Accepting new patients
Vista Medical Services, Inc. CurrentSince Feb 1, 2024 Accepting new patients

Locations

160 Rock Hill Rd
Bala Cynwyd, PA 19004
Phone (610) 667-6080

160 Rock Hill Rd
Fl 1
Bala Cynwyd, PA 19004
Phone (610) 667-5460

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1508529918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 EDGEMONT AVE",
            "city": "CLIFTON HEIGHTS",
            "state": "PA",
            "postal_code": "190181726",
            "telephone_number": "484-477-7493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 STATE RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191362908",
            "telephone_number": "215-685-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMANOU",
        "first_name": "SYMPHORIEN",
        "middle_name": "ANDRE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP024118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.