University of Penn-Medical Group
Organization Active NPI Psychiatry Physician · Philadelphia, PA
NPI 1821486846 · NPPES record last updated Nov 20, 2020
Key facts
- NPI
- 1821486846
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- UNIVERSITY OF PENN-MEDICAL GROUP
- Practice address
- 3535 Market St
3Rd Floor
Philadelphia, PA 19104-3309 - Phone
- (215) 746-6700
- NPI assigned
- Dec 29, 2014
- Organization subpart
- No
Authorized official
- Name
- Chante L Jackson, DO
- Title
- Enrollment Coor
- Phone
- (215) 662-6187
Other NPIs on the same Medicare enrollment 47
Corporate family (same tax ID) 23
Practitioners 95
-
Kelly Akah, MD
-
Hamza Alizai, M.D.
-
Jaime Anderson, CRNP
-
Rachel Blue, MD
-
Douglas Bogdanoff, LCSW
-
Martin D Cheatle, PHD
-
Gina Chester, CRNP
-
Sophia Chiu, MD
-
Benoit Dube, MD
-
Avery Bramell Ducey, PSY.D.
-
Rebekah Rae Edwards, PA-C
-
Polina Ferd, MD
-
Emma Ferguson, CRNP
-
Paige Foster, CRNP
-
Dawn Eschert Graziani, CRNP
-
Sarah Gutman, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141111000091 | PA | Part B Supplier - Clinic/Group Practice | 6204730955 |
Receives reassigned benefits from 3,792 practitioners 47 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Cobius Healthcare Solutions
Locations
3535 Market St
Fl 6
Philadelphia, PA 19104
Phone (215) 746-3311
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | PA | ||
| Rehabilitation Psychologist |
103TR0400X | PA | ||
| Social Worker |
104100000X | PA | ||
| Clinical Social Worker |
1041C0700X | |||
| Marriage & Family Therapist |
106H00000X | |||
| Neurology with Special Qualifications in Child Neurology Physician |
2084N0402X | PA | ||
| Psychiatry Physician |
2084P0800X | PA | Yes | |
| Addiction Psychiatry Physician |
2084P0802X | PA | ||
| Child & Adolescent Psychiatry Physician |
2084P0804X | PA | ||
| Geriatric Psychiatry Physician |
2084P0805X | PA |
Addresses
Primary practice location
3535 Market St
3Rd Floor
Philadelphia, PA 19104-3309
Mailing address
3535 Market St
3Rd Floor
Philadelphia, PA 19104-3309
Phone (215) 746-6700
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Philadelphia, PA
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
- University of Penn-Medical Group
All providers in Philadelphia, PA · Psychiatry Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.