NPIMap

Individual provider Active NPI

Kenneth David Chavin, MD, PHD

  • Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1801901731
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD043970E Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-5030
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X 35.130003 OH
Surgery Physician 208600000X MD043970E PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3133

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-0001
Phone (843) 792-1414

Other practice location 2

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (216) 844-2858

Other identifiers 1

IdentifierTypeStateIssuer
149850MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kennethchavin@uhps.allscriptsdirect.net

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
I20221006003217 PA Practitioner - General Surgery 4284670076 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Temple University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3008

Hospital & facility affiliations

  • Temple University Hospital Hospital, Philadelphia, PA, CCN 390027
  • Riddle Memorial Hospital Hospital, Media, PA, CCN 390222

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.130003OHMDTransplant Surgery Physician
MD043970EPAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Oct 1, 2022 Accepting new patients
Clinical Renal Associates, LLC CurrentSince May 17, 2024 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Oct 1, 2022 Accepting new patients
Temple University Hospital, Inc Past Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

30 Medical Center Blvd
Ste 303
Chester, PA 19013

2365 Heritage Center Dr
Furlong, PA 18925
Phone (215) 728-3883

100 E Lehigh Ave
Philadelphia, PA 19125
Phone (215) 707-1200

8835 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8227

3500 N Broad St
Rm 1A
Philadelphia, PA 19140
Phone (215) 707-2433

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

7500 Central Ave
Philadelphia, PA 19111
Phone (215) 214-4100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3389/brand/1/csg/21/fhir/r4

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1801901731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-3133",
            "fax_number": "215-707-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-5030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294250001",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11100 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441061716",
            "country_code": "US",
            "telephone_number": "216-844-2858",
            "fax_number": "216-844-5398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVIN",
        "first_name": "KENNETH",
        "middle_name": "DAVID",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "OH",
            "license": "35.130003",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD043970E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149850",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kennethchavin@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "11100 Euclid Ave",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441061716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.