Individual provider Active NPI

Susan E Coffin, M.D.

  • Pediatric Infectious Diseases Physician
  • Philadelphia, PA
National Provider Identifier
1619997129
Registry record updated Apr 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
MD047051L Issued in PA
Practice address
3401 Civic Center Blvd
Children'S Hospital of Phila - Infectious Diseases
Philadelphia, PA 19104-4319
Phone
(215) 590-2017
Fax
(215) 590-2025
NPI assigned
Jul 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD047051L PA
Pediatric Infectious Diseases Physician 2080P0208X MD047051L PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Children'S Hospital of Phila - Infectious Diseases
Philadelphia, PA 19104-4319

Mailing address

100 E Penn SQ
9TH Floor
Philadelphia, PA 19107-3323
Phone (267) 425-9234

Other identifiers 2

IdentifierTypeStateIssuer
001613552MedicaidPA
7120206MedicaidNJ

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
I20091203000476 PA Practitioner - Infectious Disease 7012056047 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD047051LPAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Pediatric Infectious Diseases CurrentSince Dec 13, 2010 Accepting new patients
Childen'S Health Care Associates Inc. CurrentSince Dec 13, 2010 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366329600000",
    "number": "1619997129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9234",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILA - INFECTIOUS DISEASES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-2017",
            "fax_number": "215-590-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFIN",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD047051L",
            "primary": false
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "PA",
            "license": "MD047051L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001613552",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7120206",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.