NPIMap

Individual provider Active NPI

Alan Joseph Mlodzienski, DPM

  • Foot & Ankle Surgery Podiatrist
  • Philadelphia, PA
National Provider Identifier
1790715746
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
SC003011L Issued in PA
Practice address
3801 Market St
Mab Suite #111
Philadelphia, PA 19104-3153
Phone
(215) 662-9563
Fax
(215) 243-8818
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X SC003011L PA Primary

Addresses

Primary practice location

3801 Market St
Mab Suite #111
Philadelphia, PA 19104-3153

Mailing address

3801 Market St
Mab Suite #111
Philadelphia, PA 19104-3153
Phone (215) 662-9563

Other identifiers 1

IdentifierTypeStateIssuer
0012155000010MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100913000328 PA Practitioner - Podiatry 0941280911 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3801 Market St Mab
111 Podiatry University City
Philadelphia, PA 19104-3153
Phone (215) 662-9563

Hospital & facility affiliations

  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Good Shepherd Penn Partners Long-term care hospital, Philadelphia, PA, CCN 392050

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue663
Removal or shaving of skin growth323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC003011LPAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Oct 13, 2020 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 14, 2021 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Oct 13, 2020 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 14, 2021 Accepting new patients
University of Penn - Medical Group Past Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst Past Accepting new patients

Locations

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

3801 Market St
Ste 111
Philadelphia, PA 19104
Phone (215) 662-9563

528 E Lancaster Ave
Ste 100
Radnor, PA 19087
Phone (610) 477-8244

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 7

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 4

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1790715746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 MARKET ST",
            "address_2": "MAB SUITE #111",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043153",
            "telephone_number": "215-662-9563",
            "fax_number": "215-243-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 MARKET ST",
            "address_2": "MAB SUITE #111",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043153",
            "telephone_number": "215-662-9563",
            "fax_number": "215-243-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MLODZIENSKI",
        "first_name": "ALAN",
        "middle_name": "JOSEPH",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC003011L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012155000010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.