Individual provider Active NPI

Regina Hudock

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1598021446
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
SP011942 Issued in PA
Practice address
111 S 11TH St
Suite 1950
Philadelphia, PA 19107-4824
Phone
(215) 955-9207
NPI assigned
Apr 4, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X SP011942 PA Primary

Addresses

Primary practice location

111 S 11TH St
Suite 1950
Philadelphia, PA 19107-4824

Mailing address

111 S 11TH St
Suite 1950 Gibbone
Philadelphia, PA 19107-4824

Other identifiers 1

IdentifierTypeStateIssuer
103088580MedicaidPA

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
I20160128000852 PA Practitioner - Nurse Practitioner 0446572663 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

833 Chestnut St E
7TH FLR Suite 701
Philadelphia, PA 19107-5102
Phone (215) 955-6180

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Dec 9, 2015 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jun 1, 2025 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jun 1, 2025 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

111 S 11th St
Ste 3390
Philadelphia, PA 19107
Phone (215) 955-2900

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

909 Walnut St
Fl 1
Philadelphia, PA 19107

833 Chestnut St
Ste 701
Philadelphia, PA 19107
Phone (215) 955-0735

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

1101 Chestnut St
Fl 4
Philadelphia, PA 19107

2301 S Broad St
Fl 2
Philadelphia, PA 19148
Phone (215) 952-9148

111 S 11th St
Rm 1950
Philadelphia, PA 19107
Phone (215) 955-9207

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.

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": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1598021446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 1950 GIBBONE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 1950",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDOCK",
        "first_name": "REGINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-04",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP011942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103088580",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.