Broad Street Professional Medical Services LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC

Practice address

2033 S Broad St Ste a
Philadelphia, PA 19148-5505

Phone

(215) 795-3855

Fax

(224) 235-4652

NPI assigned

Jul 11, 2019

Last updated

Jul 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ami Almeda

Title

Credentialing Manager

Phone

(224) 318-0118

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 5

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.

• Augustine D Nguyen, M.D.

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1801103668
  Medicare reassignment NPD
• Aaron Opher Shiloh, M.D.

  • Vascular & Interventional Radiology Physician
  • Philadelphia, PA
  • NPI 1003886896
  Medicare reassignment NPD
• Jennifer Brae Snavely, DO

  • Family Medicine Physician
  • State College, PA
  • NPI 1760688204
  Medicare reassignment NPD
• Yan Katsnelson, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Elk Grove Village, IL
  • NPI 1285672840

  PA

  Medicare reassignment NPD
• Alexander C Batchev, DO

  • Family Medicine Physician
  • Erie, PA
  • NPI 1316991003
  NPD (past)

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1720630650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 302",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600650302",
            "telephone_number": "847-593-8460",
            "fax_number": "224-235-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 S BROAD ST STE A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191485505",
            "telephone_number": "215-795-3855",
            "fax_number": "224-235-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "ALMEDA",
        "authorized_official_first_name": "AMI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "224-318-0118"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broad St Pharmacy
• Broad Street Braces
• Broad Street Chiropractic & Wellness Center, LLC
• Broad Street Family Pharmacy
• Broad Street Medical LLC
• Broad Wellness and Chiropractic Center, P.C.
• Louis T Broad, MD
• Michael Broadbent, COTA/L
• Ida Elise Broadwater, CRNP
• Doriean Broady, DPT

• Vascular Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Vascular Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.