NPIMap

Organization Active NPI

Fox Chase Cancer Center Medical Group, Inc

Doing business as Psych Assoc of FCCC, MGI

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1801160981
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
FOX CHASE CANCER CENTER MEDICAL GROUP, INC
Doing business as
Psych Assoc of FCCC, MGI
Practice address
333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434
Phone
(215) 728-3940
Fax
(215) 214-3901
NPI assigned
Mar 7, 2012
Last updated
Jun 14, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

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

Authorized official

Name
Tonya Woodard
Title
Credentialing/Manager
Phone
(215) 707-3911

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Psychiatry Physician 2084P0800X NU Primary
Pain Medicine (Psychiatry & Neurology) Physician 2084P2900X NU

Addresses

Primary practice location

333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 214-3940

Other identifiers 1

IdentifierTypeStateIssuer
1026888280001MedicaidPA

Other names 1

  • Psych Assoc of FCCC, MGI Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1801160981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-214-3940",
            "fax_number": "215-214-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-3940",
            "fax_number": "215-214-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX CHASE CANCER CENTER MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psych Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Psych Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.