Temple University of the Commonwealth System of Higher Education

Primary specialty

Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Doing business as

Temple Pediatric Hematology Oncology Assoc

Practice address

3509 N Broad St
Philadelphia, PA 19140-4105

Phone

(215) 707-6613

Fax

(215) 707-6629

NPI assigned

Mar 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracey Clark

Title

Director, Government and Payer Rela

Phone

(215) 707-4739

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Temple Pediatric Hematology Oncology Assoc Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649300617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 N CARLISLE ST",
            "address_2": "2ND FL HUDSON BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405108",
            "telephone_number": "215-707-3911",
            "fax_number": "215-707-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-6613",
            "fax_number": "215-707-6629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "DIRECTOR, GOVERNMENT AND PAYER RELA",
        "authorized_official_telephone_number": "215-707-4739"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130698",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Pediatric Hematology Oncology Assoc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education (Temple Cardiology Associates)
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• Temple University of the Commonwealth System of Higher Education (Temple Pediatric Anesthesiology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Vascular Surgery)
• Temple University of the Commonwealth System of Higher Education (Temple Oral Pathology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Ortorhinology Associates)
• Temple University of the Commonwealth System of Higher Education (Vaux Community Health Center)
• Temple University of the Commonwealth System of Higher Education (Temple Urology Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Physical Therapy Associates)
• Temple University of the Commonwealth System of Higher Education (Temple Internal Medicine Associates MIC)

• Pediatric Hematology & Oncology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Hematology & Oncology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.