Individual provider Active NPI

Michael F Avallone Jr., D.O.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1770526758
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS006814L Issued in PA
Practice address
2813 Cottman Ave
Philadelphia, PA 19149-1421
Phone
(215) 332-9666
Fax
(215) 332-1436
NPI assigned
Jun 14, 2006
Last updated
May 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS006814L PA Primary

Addresses

Primary practice location

2813 Cottman Ave
Philadelphia, PA 19149-1421

Mailing address

2813 Cottman Ave
Philadelphia, PA 19149-1421
Phone (215) 332-9666

Other identifiers 2

IdentifierTypeStateIssuer
0468357000OtherPAKEYSTONE PROVIDER NUMBER
4201397OtherPAAETNA HMO PROVIDER NUMBER

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
I20100517000349 PA Practitioner - Family Practice 1456489178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2813 Cottman Ave
Philadelphia, PA 19149-1421
Phone (215) 335-6165

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS006814LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Sep 11, 2023 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Family Medicine CurrentSince Sep 11, 2023 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Current Accepting new patients
Trinity Health Mid-Atlantic Medical Group Past Accepting new patients
Trinity Health Mid-Atlantic Medical Group Family Medicine Past Accepting new patients

Locations

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

2813 Cottman Ave
Philadelphia, PA 19149
Phone (215) 332-9666

Interoperability endpoints

  • Direct secure messaging: mavallone2942621@direct.trinity-health.org

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1770526758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2813 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191491421",
            "telephone_number": "215-332-9666",
            "fax_number": "215-332-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2813 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191491421",
            "telephone_number": "215-332-9666",
            "fax_number": "215-332-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVALLONE",
        "first_name": "MICHAEL",
        "middle_name": "F",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS006814L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE PROVIDER NUMBER",
            "identifier": "0468357000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO PROVIDER NUMBER",
            "identifier": "4201397",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.