Active NPI
Benjamin Petersen Soule, MD
- Allergy & Immunology Physician
- Philadelphia, PA
National Provider Identifier
1619968591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- MD440070
- Practice address
- 51 N 39TH St
Mutch BLDG. 5TH Floor
Philadelphia, PA 19104-2640 - Phone
- (215) 662-2775
- Fax
- (215) 662-3440
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD440070 | PA | |
| Allergy & Immunology Physician | 207K00000X | MD440070 | PA | Primary |
Addresses
Primary practice location
51 N 39TH St
Mutch BLDG. 5TH Floor
Philadelphia, PA 19104-2640
Mailing address
51 N 39TH St
Mutch BLDG. 5TH Floor
Philadelphia, PA 19104-2640
Phone (215) 662-2775
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 415096100 | Medicaid | MD | |
| MD440070 | Other | PA | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD440070 | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Specialists PA | Internal Medicine | Past | Accepting new patients |
| Premier Physician Group, LLC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Rockville, MD
- NPI 1700858586
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1619968591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"address_2": "MUTCH BLDG. 5TH FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-2775",
"fax_number": "215-662-3440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"address_2": "MUTCH BLDG. 5TH FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-2775",
"fax_number": "215-662-3440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOULE",
"first_name": "BENJAMIN",
"middle_name": "PETERSEN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD440070",
"primary": false
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "PA",
"license": "MD440070",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "415096100",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "MD440070",
"state": "PA"
}
],
"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 Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.