Individual provider Active NPI

Andrew R. Vogelson, PH.D.

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1770646705
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS002059L Issued in PA
Practice address
1601 Walnut St
Suite 1128
Philadelphia, PA 19102-2944
Phone
(215) 567-3638
Fax
(215) 567-5572
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSOO2059L PA
Clinical Psychologist 103TC0700X PS002059L PA Primary

Addresses

Primary practice location

1601 Walnut St
Suite 1128
Philadelphia, PA 19102-2944

Mailing address

1601 Walnut St
Suite 1128
Philadelphia, PA 19102-2944
Phone (215) 567-3638

Other identifiers 3

IdentifierTypeStateIssuer
4575442OtherPAAETNA
460554000OtherPAMAGELLAN HEALTH SERVICES
0062748000OtherPAPERSONAL CHOICE

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040513000248 PA Practitioner - Clinical Psychologist 1557351582 Reassigns benefits to 1 organization
Practice locations: Philadelphia, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Supportive Care of Pennsylvania LLCGroup PAC ID 0143521211, 91 clinicians

Practice addresses (Care Compare)

2109 Red Lion Rd
Philadelphia, PA 19115-1711
Phone (718) 298-4375

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
76.62
Improvement activities
40
Cost
78.87

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSOO2059LPAMDPsychologist
PS002059LPAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Supportive Care of Pennsylvania LLC Clinical CurrentSince Oct 15, 2021 Accepting new patients
Evergreen Counseling and Psychological Associates LLC Clinical CurrentSince Mar 20, 2017 Accepting new patients
Evergreen Counseling Associates Clinical PastSince Jan 1, 1990 Accepting new patients

Locations

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

7600 Stenton Ave
Ste 1F
Philadelphia, PA 19118
Phone (215) 247-5400

2109 Red Lion Rd
Philadelphia, PA 19115
Phone (215) 213-7000

Organizations & group practices 3

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1770646705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1128",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-567-3638",
            "fax_number": "215-567-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1128",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-567-3638",
            "fax_number": "215-567-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOGELSON",
        "first_name": "ANDREW",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PSOO2059L",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS002059L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4575442",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH SERVICES",
            "identifier": "460554000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "0062748000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.