Blessy Koshy, PA-C
Individual provider Active NPI Physician Assistant · Philadelphia, PA
NPI 1700167889 · NPPES record last updated Sep 2, 2011
Key facts
- NPI
- 1700167889
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- OA002688 (PA)
- Practice address
- 6000 N Broad St
Philadelphia, PA 19141-1900 - Phone
- (215) 424-4005
- Fax
- (215) 424-7660
- NPI assigned
- Sep 2, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eastern Pennsylvania Physician Alliance, LLC
Practice addresses (Care Compare)
4641 Roosevelt Blvd
Philadelphia, PA 19124-2343
Phone (215) 831-4600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121022000359 | PA | Practitioner - Physician Assistant | 3870743222 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OA002688 | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Einstein Practice Plan, Inc | Current |
Accepting new patients | |
| Einstein Practice Plan Inc | Current |
Accepting new patients | |
| Uhs of Pennsylvania Inc | Past | Accepting new patients |
Locations
5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180
5401 Old York Rd
Ste 4
Philadelphia, PA 19141
Phone (215) 456-6990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OA002688 | PA | Yes |
Addresses
Primary practice location
6000 N Broad St
Philadelphia, PA 19141-1900
Mailing address
6000 N Broad St
Philadelphia, PA 19141-1900
Other providers in Philadelphia, PA
- Thomas F Koscelnak
- Michele Marie Koschin
- Jenny M Koscho
- Jessica Lynn Koshinski
- Nikoloz Koshkelashvili
- Joel Koshy
- Riya Chinnu Koshy
- James John Kosik Jr.
- Jonas Kosik
- Amye Kosinski
All providers in Philadelphia, PA · Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2011. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.