Individual provider Active NPI

Katherine Deoreo Lackritz, MD

  • Obstetrics & Gynecology Physician
  • Philadelphia, PA
National Provider Identifier
1790001485
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD443245 Issued in PA
Practice address
834 Chestnut Street
Suite 300
Philadelphia, PA 19107-5127
Phone
(215) 955-5000
Fax
(215) 923-1089
NPI assigned
Apr 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 255785 NY
Obstetrics & Gynecology Physician 207V00000X MD443245 PA Primary

Addresses

Primary practice location

834 Chestnut Street
Suite 300
Philadelphia, PA 19107-5127

Mailing address

834 Chestnut Street
Suite 300
Philadelphia, PA 19107-5127
Phone (215) 955-5000

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
I20110825000057 PA Practitioner - Obstetrics/Gynecology 3971773136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Vermont College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

833 Chestnut St
Suite 1
Philadelphia, PA 19107-4420
Phone (215) 955-5000

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
255785NYMDObstetrics & Gynecology Physician
MD443245PAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Obstetrics & Gynecology CurrentSince Aug 1, 2011 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients

Locations

2130 Spring Garden St
Fl 1
Philadelphia, PA 19130
Phone (215) 955-9555

834 Chestnut St
Ste 300
Philadelphia, PA 19107
Phone (215) 955-2117

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

833 Chestnut St
Fl 1
Philadelphia, PA 19107
Phone (215) 955-1085

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.

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": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1790001485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 CHESTNUT STREET",
            "address_2": "SUITE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075127",
            "telephone_number": "215-955-5000",
            "fax_number": "215-923-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 CHESTNUT STREET",
            "address_2": "SUITE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075127",
            "telephone_number": "215-955-5000",
            "fax_number": "215-923-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKRITZ",
        "first_name": "KATHERINE",
        "middle_name": "DEOREO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "255785",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD443245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.