Individual provider Active NPI

Cody-Aaron Gathers, M.D.

  • Pediatric Cardiology Physician
  • Philadelphia, PA
National Provider Identifier
1790216646
Registry record updated Sep 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
35.157166 Issued in OH
Practice address
3401 Civic Center Blvd.
Division of Critical Care
Philadelphia, PA 19104
Phone
(267) 426-2958
NPI assigned
Mar 22, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X MT219842 PA
Pediatric Cardiology Physician 2080P0202X 35.157166 OH Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3401 Civic Center Blvd.
Division of Critical Care
Philadelphia, PA 19104

Mailing address

3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (513) 636-4200

Other practice location 1

840 Harrison Ave
Dowling 3 South Department of Pediatrics
Boston, MA 02118-2905
Phone (617) 414-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20170810000489 MA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4587935499

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT219842PAMDPediatric Critical Care Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789257600000",
    "number": "1790216646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD.",
            "address_2": "DIVISION OF CRITICAL CARE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "267-426-2958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "840 Harrison Ave",
            "address_2": "Dowling 3 South Department of Pediatrics",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182905",
            "country_code": "US",
            "telephone_number": "617-414-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GATHERS",
        "first_name": "CODY-AARON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-22",
        "last_updated": "2026-09-13",
        "certification_date": "2026-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "PA",
            "license": "MT219842",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OH",
            "license": "35.157166",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.