Individual provider Active NPI

Alfred R. Bogucki, M.D.

  • Trauma Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1740219955
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
MD042361E Issued in PA
Practice address
3998 Red Lion Rd
Suite 211
Philadelphia, PA 19114-1445
Phone
(215) 824-4559
Fax
(215) 612-9220
NPI assigned
Jul 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X MD042361E PA Primary

Addresses

Primary practice location

3998 Red Lion Rd
Suite 211
Philadelphia, PA 19114-1445

Mailing address

P. O. Box 8500 - 6335
Philadelphia, PA 19178-6335
Phone (215) 807-8000

Other identifiers 13

IdentifierTypeStateIssuer
020030561OtherPARAILROAD MEDICARE
065584000OtherPAKEYSTONE IBC
1105258OtherPACIGNA
746506OtherPAHIGHMARK BLUE SHIELD
746506OtherPAPERSONAL CHOIC E
20045179OtherPAAMERIHEALTH
3658357OtherPAAETNA HMO
0014120170011MedicaidPA
01412017-02OtherPAAMERICHOICE
30017961OtherPAKEYSTONE MERCY
1555030OtherPAUNITED HEALTHCARE
34799OtherPAHEALTH PARTNERS
PA0025546OtherPATRICARE

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
I20031119000236 PA Practitioner - General Surgery 7719891019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Pennsylvania, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aria Health Physician ServicesGroup PAC ID 3577467018, 456 clinicians

Practice addresses (Care Compare)

3998 Red Lion Rd
Philadelphia, PA 19114-1445
Phone (215) 612-4963

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)13
Hernia repair (minimally invasive)11
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD042361EPAMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Health Physician Services CurrentSince Sep 10, 2004 Accepting new patients
Aria Health Physician Services CurrentSince Sep 10, 2004 Accepting new patients
Aria Health Physician Services Current Accepting new patients
Aria Health Physician Services Past Accepting new patients
Jefferson Health - Northeast Past Accepting new patients
Jefferson Health - Northeast Past Accepting new patients

Locations

1201 Langhorne Newtown Rd
Penndel, PA 19047
Phone (215) 710-2100

3998 Red Lion Rd
Ste 235
Philadelphia, PA 19114
Phone (215) 632-3630

3998 Red Lion Rd
Philadelphia, PA 19114
Phone (215) 612-4060

5000 Frankford Ave
Ste 1B
Philadelphia, PA 19124
Phone (215) 583-2355

3998 Red Lion Rd
Ste 125
Philadelphia, PA 19114
Phone (215) 824-4559

3998 Red Lion Rd
Ste 211
Philadelphia, PA 19114
Phone (215) 612-5390

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317254400000",
    "number": "1740219955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 8500 - 6335",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191786335",
            "telephone_number": "215-807-8000",
            "fax_number": "215-612-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 RED LION RD",
            "address_2": "SUITE 211",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141445",
            "telephone_number": "215-824-4559",
            "fax_number": "215-612-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGUCKI",
        "first_name": "ALFRED",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2011-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "PA",
            "license": "MD042361E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020030561",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE IBC",
            "identifier": "065584000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1105258",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "746506",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOIC E",
            "identifier": "746506",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "20045179",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3658357",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014120170011",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "01412017-02",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "30017961",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1555030",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "34799",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "PA0025546",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.