University of Penn - Medical Group
Organization Active NPI Allergy & Immunology Physician · Philadelphia, PA
NPI 1659488351 · NPPES record last updated Nov 19, 2020
Key facts
- NPI
- 1659488351
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- Legal business name
- UNIVERSITY OF PENN - MEDICAL GROUP
- Practice address
- 3737 Market St
3Rd Floor
Philadelphia, PA 19104-5545 - Phone
- (215) 662-2775
- Fax
- (215) 615-5055
- NPI assigned
- Aug 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Chante L Jackson
- Title
- Enrollment Lead
- Phone
- (215) 662-6187
Other NPIs on the same Medicare enrollment 47
Practitioners 290
-
Charles S Abrams, MD
-
Nancy B Acri, CRNA
-
Nicole Aqui, MD
-
Vincent Arlet, MD
-
Michael Alan Ashburn, MD, MPH
-
Bahareh Assadi, MD
-
Linda J Bagley, MD
-
Olga Barg, MD
-
Catherine M Bernard, CRNA
-
Corbett Berry, MD
-
Michel Bilello, MD, PHD
-
Jordan O Booty, MD
-
Russell Bowers Jr., CRNA
-
David J Bozentka, MD
-
Mark J Brown, MD
-
Justin Brownstein, PA-C
-
Vatinee Y Bunya, MD
-
Lynn A Burtch, CRNA
-
Samantha F Butts, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141111000091 | PA | Part B Supplier - Clinic/Group Practice | 6204730955 |
Receives reassigned benefits from 3,792 practitioners 47 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
800 Walnut St
Fl 19
Philadelphia, PA 19107
Phone (215) 829-3409
800 Spruce St
Fl 4
Philadelphia, PA 19107
Phone (215) 829-3474
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | PA | Yes | |
| Allergy Physician |
207KA0200X | PA |
Addresses
Primary practice location
3737 Market St
3Rd Floor
Philadelphia, PA 19104-5545
Mailing address
3624 Market St
Suite 560W
Philadelphia, PA 19104-2614
Phone (215) 662-2286
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 496665 | Other | PA | AETNA |
| 043057 | Other | PA | BLUE SHIELD |
| 5464404 | Other | PA | NJ-MEDICAID |
| CA0235 | Other | PA | RR MEDICARE |
| 273538 | Other | PA | MAMSI |
| 145644000 | Other | PA | KEYSTONE |
| 0006610360 | Medicaid | PA | |
| G00108940 | Other | PA | AMERICHOICE |
| 0002Y20116 | Other | PA | HEALTHNET |
| 1008657 | Other | PA | MERCY |
| 06631 | Other | PA | HEALTHPARTNERS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
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All providers in Philadelphia, PA · Allergy & Immunology Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.