Individual provider Active NPI

John Lauriello, MD

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1639185291
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2009006926 Issued in MO
Practice address
833 Chestnut St Ste 210
Philadelphia, PA 19107-4405
Phone
(215) 955-6913
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 94-296 NM
Psychiatry Physician 2084P0800X 2009006926 MO Primary

Addresses

Primary practice location

833 Chestnut St Ste 210
Philadelphia, PA 19107-4405

Mailing address

833 Chestnut St Ste 210
Philadelphia, PA 19107-4405
Phone (215) 955-6913

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
I20191126002422 PA Practitioner - Psychiatry 1557457389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Temple University School of Medicine, 1986
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
2ND FLR Suite 210
Philadelphia, PA 19107-5102
Phone (215) 955-8420

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
94-296NMMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Oct 5, 2019 Accepting new patients

Locations

833 Chestnut St
Frnt 2
Philadelphia, PA 19107
Phone (215) 955-2542

833 Chestnut St
Ste 210
Philadelphia, PA 19107
Phone (215) 955-5638

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

Organizations & group practices 1

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1639185291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074405",
            "telephone_number": "215-955-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074405",
            "telephone_number": "215-955-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAURIELLO",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "94-296",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2009006926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.