Individual provider Active NPI

John T Boyle, M.D.

  • Pediatric Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1578673448
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
MD020218E Issued in PA
Practice address
3401 Civic Center Blvd
Children's Hospital of Phila - Gastro & Nutrition
Philadelphia, PA 19104-4319
Phone
(215) 590-3247
Fax
(215) 590-3606
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 24896 AL
Pediatric Gastroenterology Physician 2080P0206X MD020218E PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Children's Hospital of Phila - Gastro & Nutrition
Philadelphia, PA 19104-4319

Mailing address

100 E Penn SQ
9TH Floor
Philadelphia, PA 19107-3323
Phone (267) 425-9234

Other identifiers 3

IdentifierTypeStateIssuer
009903095MedicaidAL
09209823MedicaidMS
009901825MedicaidAL

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
I20070319000614 PA Practitioner - GastroenterologyPractitioner - Pediatric Medicine 2860595485 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24896ALMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childen's Health Care Associates Inc. CurrentSince Oct 28, 2010 Accepting new patients
Childrens Health Care Associates, Inc Pediatric Gastroenterology CurrentSince Oct 28, 2010 Accepting new patients
Childrens Health Care Associates, Inc Current Accepting new patients
The Children's Hospital of Alabama Past Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1578673448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9234",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILA - GASTRO & NUTRITION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-3247",
            "fax_number": "215-590-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYLE",
        "first_name": "JOHN",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AL",
            "license": "24896",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "MD020218E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009903095",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09209823",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009901825",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.