Peds 360 Plus Corp

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDS 360 PLUS CORP

Practice address

361 Highland Ave Ste 206
Jenkintown, PA 19046-2632

Phone

(267) 594-8734

Fax

(215) 886-2136

NPI assigned

Jan 22, 2024

Organization subpart

No

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

Authorized official

Name

Nichelle Adegbite-Maraventano, MDNPI 1891003208

Title

Owner

Phone

(267) 594-8734

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

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

• Nichelle Secorra Adegbite-Maraventano, M.D.

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1891003208

  PA, Pediatrics

  Medicare reassignment NPD Authorized official
• Jasmine Andrea Garner, CRNP, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
  • NPI 1144712258

  Family, PA

  Medicare reassignment NPD

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1730940263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 HIGHLAND AVE STE 206",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190462632",
            "telephone_number": "267-594-8734",
            "fax_number": "215-886-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 HIGHLAND AVE STE 206",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190462632",
            "telephone_number": "267-594-8734",
            "fax_number": "215-886-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDS 360 PLUS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "ADEGBITE-MARAVENTANO",
        "authorized_official_first_name": "NICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "267-594-8734",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jenkintown, PA
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.