Active NPI
Gyan Chetan Moorthy, MBE
- Pediatrics Physician
- Philadelphia, PA
National Provider Identifier
1649072307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MT234481
- Practice address
- 3401 Civic Center Blvd
Division of General Pediatrics
Philadelphia, PA 19104-4319 - Phone
- (915) 222-1513
- NPI assigned
- Mar 25, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MT234481 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Division of General Pediatrics
Philadelphia, PA 19104-4319
Mailing address
104 Camino Penasco
El Paso, TX 79912-3438
Phone (915) 222-1513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT234481 | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749600000000",
"number": "1649072307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 CAMINO PENASCO",
"city": "EL PASO",
"state": "TX",
"postal_code": "799123438",
"telephone_number": "915-222-1513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "DIVISION OF GENERAL PEDIATRICS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "915-222-1513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORTHY",
"first_name": "GYAN",
"middle_name": "CHETAN",
"name_prefix": "Mr.",
"credential": "MBE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-25",
"last_updated": "2025-06-11",
"certification_date": "2025-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MT234481",
"primary": true
}
],
"identifiers": [],
"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 Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.