Individual provider Active NPI

Alizabeth Berry, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1699130112
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA058039 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 955-6000
NPI assigned
Dec 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA058039 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

925 Chestnut St Ste 320a
Philadelphia, PA 19107-4216
Phone (215) 955-8874

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190103003260 PA Practitioner - Physician Assistant 9739425265 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Philadelphia, PA 19107-4824

925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA058039PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Nov 14, 2018 Accepting new patients
Temple Physicians Inc. Medical CurrentSince Dec 15, 2019 Accepting new patients
Temple Physician Inc. CurrentSince Dec 15, 2019 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

515 Pennsylvania Ave
Fl 2
Ft Washington, PA 19034
Phone (215) 540-0120

925 Chestnut St
Ste 320A
Philadelphia, PA 19107
Phone (215) 955-1175

111 S 11th St
#3
Philadelphia, PA 19107
Phone (215) 955-7074

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1451260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544745600000",
    "number": "1699130112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST STE 320A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "215-955-8874",
            "fax_number": "215-955-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "ALIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-28",
        "last_updated": "2018-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA058039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.