Individual provider Active NPI

Mark B Wenneker, DO

  • Physical Medicine & Rehabilitation Physician
  • Philadelphia, PA
National Provider Identifier
1730128257
Registry record updated Dec 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
OS013472 Issued in PA
Practice address
1800 Lombard Street
1St Floor
Philadelphia, PA 19146
Phone
(215) 893-2645
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X OS013472 PA Primary

Addresses

Primary practice location

1800 Lombard Street
1St Floor
Philadelphia, PA 19146

Mailing address

1800 Lombard Street
1St Floor
Philadelphia, PA 19146
Phone (215) 893-2645

Other identifiers 2

IdentifierTypeStateIssuer
101488671MedicaidPA
0192015MedicaidNJ

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
I20060210000294 PA Practitioner - Physical Medicine and Rehabilitation 7315952470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
West Virginia School of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS013472PAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Physical Medicine & Rehabilitation CurrentSince Apr 1, 2015 Accepting new patients
University of Penn-Medical Group CurrentSince Apr 1, 2015 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

1800 Lombard St
Fl 1
Philadelphia, PA 19146
Phone (215) 893-2600

1800 Lombard St
Philadelphia, PA 19146
Phone (215) 545-4173

3400 Spruce St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-3005

3400 Spruce St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-2428

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Organizations & group practices 4

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 2

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386288000000",
    "number": "1730128257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 LOMBARD STREET",
            "address_2": "1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-893-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 LOMBARD STREET",
            "address_2": "1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-893-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNEKER",
        "first_name": "MARK",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2013-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "OS013472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101488671",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0192015",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.