NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

Doing business as Temple Psychiatry Associates

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1538157656
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
Temple Psychiatry Associates
Practice address
100 E Lehigh Ave BLDG Suite105
Philadelphia, PA 19125-1012
Phone
(215) 707-8496
Fax
(215) 707-4086
NPI assigned
Oct 12, 2005
Last updated
Jun 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Authorized official

Name
Tonya Woodard
Title
Manager, Credentialing
Phone
(215) 707-3911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

100 E Lehigh Ave BLDG Suite105
Philadelphia, PA 19125-1012

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-8496

Other practice location 1

7600 Central Ave
Philadelphia, PA 19111-2442
Phone (215) 722-3258

Other practice location 2

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-8296

Other practice location 3

1316 W Ontario St
Philadelphia, PA 19140-5220
Phone (215) 707-8496

Other identifiers 4

IdentifierTypeStateIssuer
1007780130755MedicaidPA
1007780130831MedicaidPA
1007780130695MedicaidPA
1007780130754MedicaidPA

Other names 1

  • Temple Psychiatry Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000333 PA Part B Supplier - Clinic/Group Practice 2961314299 Receives reassigned benefits from 19 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1538157656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE BLDG SUITE105",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251012",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112442",
            "country_code": "US",
            "telephone_number": "215-722-3258",
            "fax_number": "215-722-3863",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3509 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191404105",
            "country_code": "US",
            "telephone_number": "215-707-8296",
            "fax_number": "215-707-4086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1316 W Ontario St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405220",
            "country_code": "US",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130755",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130831",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130695",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130754",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Psychiatry Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Psychiatry Associates",
            "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 Jun 15, 2018; 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.