Individual provider Active NPI

Jeffrey Mark Ewig, M.D.

  • Pediatric Pulmonology Physician
  • Philadelphia, PA
National Provider Identifier
1669453148
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
MD453612 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104
Phone
(215) 590-1000
Fax
(215) 590-3500
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X MD453612 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104

Mailing address

100 Penn Square East
9TH Floor North Tower
Philadelphia, PA 19107
Phone (267) 425-9200

Other identifiers 1

IdentifierTypeStateIssuer
1029947970001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150225000605 NJ Practitioner - Pulmonary DiseasePractitioner - Pediatric Medicine 6800783192 Reassigns benefits to 1 organization
I20150225002080 PA Practitioner - Pulmonary DiseasePractitioner - Pediatric Medicine 6800783192 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc CurrentSince Jan 5, 2015 Accepting new patients
Childens Health Care Associates of New Jersey PC CurrentSince Jan 1, 2015 Accepting new patients
Childrens Health Care Associates of New Jersey PC CurrentSince Jan 1, 2015 Accepting new patients
Childrens Health Care Associates, Inc Current Accepting new patients
Childen's Health Care Associates Inc. CurrentSince Jan 5, 2015 Accepting new patients
Childrens Health Care Associates of New Jersey PC Current Accepting new patients

Locations

101 Plainsboro Rd
Plainsboro, NJ 08536
Phone (267) 425-9505

707 Alexander Rd
Princeton, NJ 08540
Phone (609) 520-1717

100 Bowman Dr
Voorhees, NJ 08043
Phone (856) 247-3000

1840 Susquehanna Rd
Abington, PA 19001
Phone (215) 590-2169

500 W Butler Ave
Chalfont, PA 18914
Phone (215) 997-5730

550 S Goddard Blvd
King of Prussia, PA 19406
Phone (610) 337-3232

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1669453148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PENN SQUARE EAST",
            "address_2": "9TH FLOOR NORTH TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "267-425-9200",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-1000",
            "fax_number": "215-590-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWIG",
        "first_name": "JEFFREY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "PA",
            "license": "MD453612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029947970001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.