Individual provider Active NPI

Carol Gung, RN, MSN, AGNP-BC

  • Gerontology Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1750896866
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN302959L Issued in PA
Practice address
925 Chestnut St Ste 420a
Philadelphia, PA 19107-4216
Phone
(215) 955-8874
NPI assigned
Dec 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X RN302959L PA Primary

Addresses

Primary practice location

925 Chestnut St Ste 420a
Philadelphia, PA 19107-4216

Mailing address

2016 Longshore Ave
Philadelphia, PA 19149-1815
Phone (267) 205-2727

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180531000651 PA Practitioner - Nurse Practitioner 4082979620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN302959LPAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Apr 16, 2018 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

925 Chestnut St
Ste 420A
Philadelphia, PA 19107
Phone (215) 955-8516

925 Chestnut St
Fl 3
Philadelphia, PA 19107
Phone (215) 503-6654

925 Chestnut St
Ste 320A
Philadelphia, PA 19107
Phone (215) 955-1175

1101 Chestnut St
Fl 14
Philadelphia, PA 19107
Phone (215) 955-8084

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

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": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1750896866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 LONGSHORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191491815",
            "telephone_number": "267-205-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST STE 420A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "215-955-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNG",
        "first_name": "CAROL",
        "name_prefix": "Ms.",
        "credential": "RN, MSN, AGNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-12",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "RN302959L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.