Individual provider Active NPI

Wakengo Mahaniah, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1710156294
Registry record updated Nov 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD435219 Issued in PA
Practice address
5000 Woodland Ave
Philadelphia, PA 19143-5137
Phone
(215) 726-9807
Fax
(215) 726-6424
NPI assigned
Feb 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD435219 PA Primary

Addresses

Primary practice location

5000 Woodland Ave
Philadelphia, PA 19143-5137

Mailing address

1401 S 31St St
2ND Floor
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other identifiers 1

IdentifierTypeStateIssuer
102216961MedicaidPA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081111000070 PA Practitioner - Family Practice 4486713187 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

1316 W Ontario St
Philadelphia, PA 19140-5220
Phone (215) 707-2400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD435219PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Greater Philadelphia Health Action, Inc. CurrentSince Oct 24, 2016 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Oct 4, 2023 Accepting new patients
Greater Philadelphia Health Action Inc. CurrentSince Oct 24, 2016 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Oct 4, 2023 Accepting new patients
Greater Philadelphia Health Action Inc. Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

8815 Germantown Ave
Fl 5
Philadelphia, PA 19118
Phone (215) 248-8145

100 E Lehigh Ave
Philadelphia, PA 19125
Phone (215) 707-1200

432 N 6th St
Philadelphia, PA 19123
Phone (215) 627-8000

5000 Woodland Ave
Philadelphia, PA 19143
Phone (215) 726-9807

8815 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8145

1999 W Hunting Park Ave
Philadelphia, PA 19140
Phone (215) 228-9300

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

1316 W Ontario St
Philadelphia, PA 19140
Phone (215) 707-2400

5501 Woodland Ave
Philadelphia, PA 19143
Phone (215) 724-4700

1401 S 31st St
#2
Philadelphia, PA 19146

Interoperability endpoints

  • Direct secure messaging: wakengo.mahaniah@49428401684484.direct.elationemr.com

Organizations & group practices 8

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": "1204156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510617600000",
    "number": "1710156294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191435137",
            "telephone_number": "215-726-9807",
            "fax_number": "215-726-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHANIAH",
        "first_name": "WAKENGO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-28",
        "last_updated": "2017-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD435219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102216961",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.