Temple University of the Commonwealth System of Higher Education

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Doing business as

Temple Vascular Surgery

Practice address

3509 N Broad St
Philadelphia, PA 19140

Phone

(215) 707-8484

Fax

(215) 707-3945

NPI assigned

Oct 12, 2005

Last updated

Jun 15, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tonya Woodard

Title

Credentialing/Manager

Phone

(215) 707-3911

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Temple Vascular Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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": "1619965712",
    "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": "215-707-8484",
            "fax_number": "215-707-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19140",
            "telephone_number": "215-707-8484",
            "fax_number": "215-707-3945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7500 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112430",
            "country_code": "US",
            "telephone_number": "215-707-3133",
            "fax_number": "215-707-3975",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Huntingdon Pike",
            "address_purpose": "LOCATION",
            "city": "Meadowbrook",
            "state": "PA",
            "postal_code": "190468004",
            "country_code": "US",
            "telephone_number": "215-938-1660",
            "fax_number": "215-938-2186",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-3133",
            "fax_number": "215-707-3945",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5800 Ridge Avenue",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19128",
            "country_code": "US",
            "telephone_number": "267-707-3133",
            "fax_number": "215-707-3945",
            "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": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130785",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130786",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130830",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130684",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130783",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Vascular Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Vascular Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education (Temple Audiology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Psychiatry Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Cardiology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Neurosurgical)
• Temple University of the Commonwealth System of Higher Education (Temple Pediatric Anesthesiology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Oral Pathology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Pediatric Hematology Oncology Assoc)
• Temple University of the Commonwealth System of Higher Education (Temple Ortorhinology Associates)
• Temple University of the Commonwealth System of Higher Education (Vaux Community Health Center)
• Temple University of the Commonwealth System of Higher Education (Temple Urology Associates)

• Vascular Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Vascular Surgery Physician in Pennsylvania

• 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.