NPIMap

Organization Active NPI

Drexel University

Doing business as Drexel Sports Medicine

  • Sports Medicine (Family Medicine) Physician
  • Philadelphia, PA
National Provider Identifier
1689842072
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
DREXEL UNIVERSITY
Doing business as
Drexel Sports Medicine
Practice address
10 Shurs LN
Philadelphia, PA 19127-2123
Phone
(215) 482-1234
NPI assigned
Feb 19, 2008
Last updated
Jul 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Authorized official

Name
David Janiec
Title
Director of Payer Contracting
Phone
(215) 255-7766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X PA Primary

Addresses

Primary practice location

10 Shurs LN
Philadelphia, PA 19127-2123

Mailing address

1601 Cherry St
Suite 11511
Philadelphia, PA 19102-1321
Phone (215) 255-7822

Other names 1

  • Drexel Sports Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140729001682 PA Part B Supplier - Clinic/Group Practice 5496664740 Receives reassigned benefits from 340 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Warminster, PA; Elkins Park, PA

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

National Provider Directory

National Provider Directory
Tax ID family
Drexel University21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

1427 Vine St
Fl 2
Philadelphia, PA 19102
Phone (215) 762-2530

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1689842072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CHERRY ST",
            "address_2": "SUITE 11511",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021321",
            "telephone_number": "215-255-7822",
            "fax_number": "215-255-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SHURS LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191272123",
            "telephone_number": "215-482-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DREXEL UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "JANIEC",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR OF PAYER CONTRACTING",
        "authorized_official_telephone_number": "215-255-7766"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drexel Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 9, 2014; 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.