NPIMap

Individual provider Active NPI

Fottfam Baguio Labouff, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1770089930
Registry record updated Apr 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA059727 Issued in PA
Practice address
555 S 43Rd St
Philadelphia, PA 19104-4408
Phone
(215) 685-7504
NPI assigned
Apr 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA059727 PA Primary

Addresses

Primary practice location

555 S 43Rd St
Philadelphia, PA 19104-4408

Mailing address

7240 Ridge Ave
Philadelphia, PA 19128-3203
Phone (209) 598-3180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180514000227 PA Practitioner - Physician Assistant 9335403658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of PhiladelphiaGroup PAC ID 6305758723, 86 clinicians

Practice addresses (Care Compare)

4400 Haverford Ave
Philadelphia, PA 19104-1361
Phone (215) 685-7630

555 S 43 St
Philadelphia, PA 19104-4408
Phone (215) 685-7522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA059727PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
City of Philadelphia CurrentSince Apr 30, 2018 Accepting new patients
City of Philadelphia CurrentSince Apr 30, 2018 Accepting new patients

Locations

555 S 43rd St
Philadelphia, PA 19104
Phone (215) 685-7500

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

1101 Market St
Fl 10
Philadelphia, PA 19107

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522800000000",
    "number": "1770089930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7240 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191283203",
            "telephone_number": "209-598-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S 43RD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044408",
            "telephone_number": "215-685-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABOUFF",
        "first_name": "FOTTFAM",
        "middle_name": "BAGUIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2018-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA059727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.