Temple University of the Commonwealth System of Higher Education

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Practice address

3509 N Broad St
Philadelphia, PA 19140-4105

Phone

(215) 707-3375

Fax

(215) 707-4758

NPI assigned

Oct 12, 2005

Organization subpart

No

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

Authorized official

Name

Tonya Woodard

Title

Manager, Credentialing

Phone

(215) 707-3911

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Temple Urology Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1700874807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8380 Old York Rd",
            "address_purpose": "LOCATION",
            "city": "Elkins Park",
            "state": "PA",
            "postal_code": "190271539",
            "country_code": "US",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4817 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191412107",
            "country_code": "US",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7500 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112430",
            "country_code": "US",
            "telephone_number": "215-707-3375",
            "fax_number": "215-707-4758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "255 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191036231",
            "country_code": "US",
            "telephone_number": "215-875-9710",
            "fax_number": "215-875-9714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130822",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130771",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130774",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130772",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130773",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130775",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Urology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Urology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education

• Urology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Urology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; 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.