Individual provider Active NPI

Kenn R Ghaffarian, D.O.

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1578825816
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS017806 Issued in PA
Practice address
10800 Knights Rd
Philadelphia, PA 19114-4200
Phone
(215) 612-4963
NPI assigned
Jun 12, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OT014540 PA
Emergency Medicine Physician 207P00000X OS017806 PA Primary

Addresses

Primary practice location

10800 Knights Rd
Philadelphia, PA 19114-4200

Mailing address

10800 Knights Rd
Philadelphia, PA 19114-4200
Phone (215) 612-4963

Other practice location 1

1020 Sansome Street
Suite 239
Philadelphia, PA 19107-5002
Phone (215) 955-6844

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
I20160719001968 PA Practitioner - Emergency Medicine 5991098576 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aria Health Physician ServicesGroup PAC ID 3577467018, 456 clinicians

Practice addresses (Care Compare)

3998 Red Lion Rd
Philadelphia, PA 19114-1436
Phone (215) 969-1500

Hospital & facility affiliations

  • Jefferson Health- Northeast Hospital, Philadelphia, PA, CCN 390115

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT014540PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc Current Accepting new patients
Aria Health Physician Services CurrentSince Jul 1, 2017 Accepting new patients
Aria Health Physician Services Current Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Jul 9, 2019 Accepting new patients
Aria Health Physician Services CurrentSince Jul 1, 2017 Accepting new patients
Jefferson University Physicians Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Einstein Practice Plan, Inc CurrentSince Jun 24, 2016 Accepting new patients
Jefferson Acute Care Physicians, PC Current Accepting new patients
Einstein Practice Plan Inc CurrentSince Jun 24, 2016 Accepting new patients

Locations

2966 Street Rd
Bensalem, PA 19020
Phone (215) 638-0666

2451 Grant Ave
Philadelphia, PA 19114
Phone (215) 464-8050

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1020 Sansom St
Ste 239
Philadelphia, PA 19107
Phone (215) 955-6844

2301 S Broad St
Fl 1
Philadelphia, PA 19148
Phone (215) 952-9136

10800 Knights Rd
Philadelphia, PA 19114
Phone (215) 612-2610

5501 York Rd
Philadelphia, PA 19141
Phone (215) 456-7405

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

3998 Red Lion Rd
Philadelphia, PA 19114
Phone (215) 612-4060

559 W Germantown Pike
West Norriton, PA 19403
Phone (484) 622-1000

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1578825816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 KNIGHTS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191144200",
            "telephone_number": "215-612-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 KNIGHTS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191144200",
            "telephone_number": "215-612-4963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 Sansome Street",
            "address_2": "Suite 239",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191075002",
            "country_code": "US",
            "telephone_number": "215-955-6844",
            "fax_number": "215-955-2526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GHAFFARIAN",
        "first_name": "KENN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT014540",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS017806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.