Individual provider Active NPI

Marc-Andre Gascon, P.A.

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1790294585
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA063516 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-3309
Phone
(215) 349-8310
Fax
(215) 893-7270
NPI assigned
Sep 25, 2017
Last updated
Apr 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA063516 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-3309

Mailing address

3400 Spruce St
Philadelphia, PA 19104-3309
Phone (215) 349-8310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221104000982 NJ Practitioner - Physician Assistant 4981071917 Reassigns benefits to 1 organization
I20230214000077 PA Practitioner - Physician Assistant 4981071917 Reassigns benefits to 2 organizations

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
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA063516PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Jun 12, 2023 Accepting new patients
Cooper Surgical Associates, PA CurrentSince Oct 1, 2022 Accepting new patients
University of Penn - Medical Group CurrentSince Nov 2, 2022 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 2, 2022 Accepting new patients

Locations

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

3 Cooper Plz
Rm 411
Camden, NJ 08103
Phone (856) 342-2270

51 N 39th St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-9010

Interoperability endpoints

  • Direct secure messaging: mgascon128211@direct.cooperhealth.edu

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 2

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": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1790294585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043309",
            "telephone_number": "215-349-8310",
            "fax_number": "215-893-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043309",
            "telephone_number": "215-349-8310",
            "fax_number": "215-893-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASCON",
        "first_name": "MARC-ANDRE",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-25",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA063516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.