NPIMap

Organization Active NPI

Mt. Airy Pediatrics, P.C.

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1730516659
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MT. AIRY PEDIATRICS, P.C.
Practice address
6673 Germantown Ave
Philadelphia, PA 19119-2252
Phone
(215) 247-2996
Fax
(215) 247-7504
NPI assigned
Oct 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Authorized official

Name
Jennifer Louis Jadotte
Title
Practice Manager
Phone
(215) 247-2996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

6673 Germantown Ave
Philadelphia, PA 19119-2252

Mailing address

6673 Germantown Ave
Philadelphia, PA 19119-2252
Phone (215) 247-2996

Other identifiers 5

IdentifierTypeStateIssuer
000465921OtherPABLUE SHIELD/HIGH MARK
1781620OtherPAUNITED HEALTHCARE
6524OtherPAAETNA
1026452OtherPAKEYSTONE MERCY
0055732001OtherPAINDEPENDENCE BLUE CROSS

Other names 1

  • Mt. Airy Pediatrics, PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210510002087 PA Part B Supplier - Mass Immunization (Roster Biller Only) 3274942966 Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

7056 Germantown Ave
Ste 102
Philadelphia, PA 19119
Phone (215) 247-2996

7056 Germantown Ave
Philadelphia, PA 19119
Phone (215) 242-2523

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1730516659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6673 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192252",
            "telephone_number": "215-247-2996",
            "fax_number": "215-247-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6673 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192252",
            "telephone_number": "215-247-2996",
            "fax_number": "215-247-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. AIRY PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "LOUIS JADOTTE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "215-247-2996"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD/HIGH MARK",
            "identifier": "000465921",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1781620",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6524",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "1026452",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0055732001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Airy Pediatrics, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; 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.