Active NPI
Travis A Cos, PH.D.
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1639365174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS016774
- Practice address
- 1200 Callowhill St
PHMC Care Clinic, Suite 101
Philadelphia, PA 19123-3658 - Phone
- (215) 825-8220
- Fax
- (215) 825-8254
- NPI assigned
- Sep 19, 2007
- Last updated
- Jul 15, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | NU | ||
| Clinical Psychologist | 103TC0700X | PS016774 | PA | Primary |
| Clinical Psychologist | 103TC0700X | 018246-1 | NY |
Addresses
Primary practice location
1200 Callowhill St
PHMC Care Clinic, Suite 101
Philadelphia, PA 19123-3658
Mailing address
1500 Market Street
LM 500 West Tower
Philadelphia, PA 19120-2100
Phone (215) 985-2595
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1312677 | Medicaid | MA | |
| 685661 | Other | MA | TUFTS |
| M18708 | Other | MA | BLUE CROSS |
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS016774 | PA | MD | Clinical Psychologist |
| 018246-1 | NY | MD | Specialist |
Interoperability endpoints
- traviscos@nncc.allscriptsdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1639365174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 MARKET STREET",
"address_2": "LM 500 WEST TOWER",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191202100",
"telephone_number": "215-985-2595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CALLOWHILL ST",
"address_2": "PHMC CARE CLINIC, SUITE 101",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191233658",
"telephone_number": "215-825-8220",
"fax_number": "215-825-8254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COS",
"first_name": "TRAVIS",
"middle_name": "A",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS016774",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018246-1",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1312677",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "685661",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "M18708",
"state": "MA"
}
],
"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 Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.