NPIMap

Individual provider Active NPI

Raquel Inniss, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1790725703
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD074296 Issued in PA
Practice address
9331 Old Bustleton Ave Ste 201
Philadelphia, PA 19115-4204
Phone
(215) 602-8500
Fax
(215) 676-6507
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD074296 PA
Internal Medicine Physician 207R00000X MD074296 PA Primary

Addresses

Primary practice location

9331 Old Bustleton Ave Ste 201
Philadelphia, PA 19115-4204

Mailing address

9331 Old Bustleton Ave Ste 201
Phila, PA 19115-4204
Phone (215) 602-8500

Other identifiers 1

IdentifierTypeStateIssuer
01951255MedicaidPA

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
I20130314000043 PA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6305081605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Howard University College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Temple Physicians IncGroup PAC ID 2062317233, 154 clinicians

Practice addresses (Care Compare)

9331 Old Bustleton Ave
Suite 201
Philadelphia, PA 19115-4204
Phone (215) 602-8500

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Newtown, PA, CCN 397015
  • Holy Redeemer Home Care-PA Home health agency, Philadelphia, PA, CCN 397104
  • Temple University Hospital Hospital, Philadelphia, PA, CCN 390027
  • Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD074296PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Physicians Inc Internal Medicine Current Accepting new patients
Temple Physicians Inc. Internal Medicine CurrentSince Sep 1, 2022 Accepting new patients
Temple Physician Inc. Internal Medicine CurrentSince Sep 1, 2022 Accepting new patients
Temple Physicians Inc. Past Accepting new patients
Temple Physicians Inc Past Accepting new patients

Locations

515 Pennsylvania Ave
Fl 2
Ft Washington, PA 19034
Phone (215) 540-0120

9331 Old Bustleton Ave
Ste 201
Philadelphia, PA 19115
Phone (215) 602-8500

Organizations & group practices 5

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 11

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1790725703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9331 OLD BUSTLETON AVE STE 201",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191154204",
            "telephone_number": "215-602-8500",
            "fax_number": "215-676-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9331 OLD BUSTLETON AVE STE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191154204",
            "telephone_number": "215-602-8500",
            "fax_number": "215-676-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNISS",
        "first_name": "RAQUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD074296",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD074296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01951255",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.