Active NPI
Aidan Petrovich
- Internal Medicine Physician
- Philadelphia, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MT233119
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (267) 425-1650
- NPI assigned
- Mar 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | MT233119 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
PO Box 512
Crystal Beach, FL 34681-0512
Phone (214) 596-8172
Other practice location 1
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-4000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT233119 | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Penn-Medical Group | Current | Accepting new patients | |
| University of Penn - Medical Group | Internal Medicine | Current | Accepting new patients |
| University of Penn - Medical Group | Past | Accepting new patients |
Locations
3400 Spruce St
Fl 5
Philadelphia, PA 19104
Phone (215) 662-2777
Organizations & group practices 3
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.
-
- Hospitalist Physician
- Philadelphia, PA
- NPI 1053447151
Internal Medicine
-
- Surgical Oncology Physician
- Philadelphia, PA
- NPI 1871981985
-
- Cardiovascular Disease Physician
- Philadelphia, PA
- NPI 1093725145
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1245207521
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749427200000",
"number": "1619617735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 512",
"city": "CRYSTAL BEACH",
"state": "FL",
"postal_code": "346810512",
"telephone_number": "214-596-8172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "267-425-1650"
}
],
"practiceLocations": [
{
"address_1": "1000 Medical Center Blvd",
"address_purpose": "LOCATION",
"city": "Lawrenceville",
"state": "GA",
"postal_code": "300467694",
"country_code": "US",
"telephone_number": "678-312-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETROVICH",
"first_name": "AIDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-29",
"last_updated": "2025-06-09",
"certification_date": "2025-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MT233119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
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 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.