Individual provider Active NPI

Sanju George, M.D.

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1659786911
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD462505 Issued in PA
Practice address
9730 Wynmill Rd
Philadelphia, PA 19115-1804
Phone
(267) 978-1582
NPI assigned
Jun 25, 2014
Last updated
Apr 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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 MD462505 PA Primary
Child & Adolescent Psychiatry Physician 2084P0804X MT212557 PA

Addresses

Primary practice location

9730 Wynmill Rd
Philadelphia, PA 19115-1804

Mailing address

9730 Wynmill Rd
Philadelphia, PA 19115-1804
Phone (267) 978-1582

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
I20191211000028 PA Practitioner - Psychiatry 3779916432 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastern Pennsylvania Physician Alliance, LLCGroup PAC ID 8325478662, 112 clinicians

Practice addresses (Care Compare)

4641 Roosevelt Blvd
Philadelphia, PA 19124-2343
Phone (215) 831-4600

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
78.42
Improvement activities
40
Cost
70.24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD462505PAMDPsychiatry Physician
MT212557PAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Uhs of Pennsylvania Inc Psychiatry Current Accepting new patients
Uhs of Pennsylvania Inc Psychiatry CurrentSince Oct 12, 2019 Accepting new patients
Eastern Pennsylvania Physician Alliance LLC Child & Adolescent Psychiatry CurrentSince Jun 1, 2020 Accepting new patients

Locations

800 Park Way
Ste A
Broomall, PA 19008
Phone (215) 718-4350

2 Hospital Dr
Clarion, PA 16214
Phone (800) 253-4906

722 E Butler Pike
Maple Glen, PA 19002
Phone (215) 643-7800

4641 E Roosevelt Blvd
Philadelphia, PA 19124
Phone (215) 831-4600

601 Roxbury Rd
Shippensburg, PA 17257
Phone (717) 532-4217

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1659786911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 WYNMILL RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191151804",
            "telephone_number": "267-978-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 WYNMILL RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191151804",
            "telephone_number": "267-978-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "SANJU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD462505",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "MT212557",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.