West Cayuga Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WEST CAYUGA MEDICINE PC

Practice address

257 W Cayuga St
Philadelphia, PA 19140-2439

Phone

(267) 368-6953

Fax

(215) 621-6940

NPI assigned

Oct 27, 2016

Organization subpart

No

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

Authorized official

Name

Fabian A VengoecheaNPI 1033150800

Title

Owner & Ceo

Phone

(267) 368-6953

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• West Cayuga Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fabian A Vengoechea, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1033150800
  Medicare reassignment Care Compare group NPD Authorized official
• Jessica O'Driscoll

  • Psychiatric/Mental Health Nurse Practitioner
  • Springfield, PA
  • NPI 1053846428
  Medicare reassignment Care Compare group NPD
• Lea Michelle Isaac, D.O.

  • Obstetrics & Gynecology Physician
  • Media, PA
  • NPI 1770795106
  Medicare reassignment NPD
• Yun Mi Kim

  • Psychiatric/Mental Health Nurse Practitioner
  • Springfield, PA
  • NPI 1750938288
  Medicare reassignment NPD
• Jacqueline M Redman, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
  • NPI 1063753598
  Medicare reassignment NPD

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1811449697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 W CAYUGA ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402439",
            "telephone_number": "267-368-6953",
            "fax_number": "215-621-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W CAYUGA ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402439",
            "telephone_number": "267-368-6953",
            "fax_number": "215-621-6940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Baltimore Pike Ste 9B",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "PA",
            "postal_code": "190642862",
            "country_code": "US",
            "telephone_number": "267-368-6953",
            "fax_number": "215-621-6940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WEST CAYUGA MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A",
        "authorized_official_last_name": "VENGOECHEA",
        "authorized_official_first_name": "FABIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER & CEO",
        "authorized_official_telephone_number": "267-368-6953"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103229169",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Cayuga Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Cayuga Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew Wesolowski
• Jeffrey Wesolowski, DPT
• Rachel G Wesseh
• Judith Buda Wessell, CRNP
• Rosalie Winter Wessell, PHD, M.D.
• West Coast Optical
• West Oak Lane Charter School
• West Phila Community Mental Health Consortium, Inc
• West Phila Community Mental Health Consortium, Inc.
• West Phila Community Mental Health Consortium, Inc.

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.