Temple University of the Commonwealth System of Higher Education

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Practice address

3401 N Broad St
Philadelphia, PA 19140-5103

Phone

(215) 707-1622

Fax

(215) 707-0943

NPI assigned

Oct 6, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Tonya M Woodard

Title

Credentialing/Manager

Phone

(215) 707-3911

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Temple Internal Medicine Associates MIC 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": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1730177585",
    "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": "215-707-1622",
            "fax_number": "215-707-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-1622",
            "fax_number": "215-707-0943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Lehigh Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191251012",
            "country_code": "US",
            "telephone_number": "215-707-1622",
            "fax_number": "215-707-0943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-5067",
            "fax_number": "215-707-5126",
            "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": "215-707-5067",
            "fax_number": "215-707-5126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Ft Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-5067",
            "fax_number": "215-707-5126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Ostrum St",
            "address_purpose": "LOCATION",
            "city": "Bethlehem",
            "state": "PA",
            "postal_code": "180151155",
            "country_code": "US",
            "telephone_number": "215-707-5067",
            "fax_number": "215-707-5126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "450 Cresson Blvd",
            "address_purpose": "LOCATION",
            "city": "Phoenixville",
            "state": "PA",
            "postal_code": "194606127",
            "country_code": "US",
            "telephone_number": "215-707-5067",
            "fax_number": "215-707-5126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hepatology",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130728",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130729",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130726",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130740",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130105",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130734",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Internal Medicine Associates MIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Internal Medicine Associates MIC",
            "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

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine 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.