Imagine Medical Group, PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

IMAGINE MEDICAL GROUP, PA

Doing business as

Innovatel Medical

Practice address

100 S Juniper St FL 3
Philadelphia, PA 19107-1316

Phone

(267) 999-9534

NPI assigned

Apr 20, 2022

Organization subpart

No

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

Authorized official

Name

Robert Wilson, MD

Title

President

Phone

(814) 392-8679

Specialties & licenses 3

Addresses

Other names 1

• Innovatel Medical Doing business as

Locations

Practitioners 7

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

• Eryn Dulaney, MSSW

  • Clinical Social Worker
  • Lexington, NC
  • NPI 1902265283
  NPD
• Adam R Sasso, M.D.

  • Family Medicine Physician
  • Wilton Manors, FL
  • NPI 1760612758
  NPD
• Ayesha K Ashai, M.D.

  • Forensic Psychiatry Physician
  • Erie, PA
  • NPI 1174866800
  NPD (past)
• Meaghan M Casey, M.D., M.S.

  • Psychiatry Physician
  • Erie, PA
  • NPI 1700014008
  NPD (past)
• Nichole Lee Sonderman, M.D.

  • Child & Adolescent Psychiatry Physician
  • Erie, PA
  • NPI 1114217270
  NPD (past)
• Joshua Robert Ackerman, MD

  • Psychiatry Physician
  • Saint Cloud, MN
  • NPI 1548677974
  NPD (past)
• Eve Kellner, D.O.

  • Psychiatry Physician
  • Kalamazoo, MI
  • NPI 1306286067

  Neurology

  NPD (past)

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1821731548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 PARK AVE S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100031502",
            "telephone_number": "267-999-9534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S JUNIPER ST FL 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191071316",
            "telephone_number": "267-999-9534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2815 Elliott Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981212991",
            "country_code": "US",
            "telephone_number": "206-316-1106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Gateway Ctr Ste 2600",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NJ",
            "postal_code": "071025323",
            "country_code": "US",
            "telephone_number": "267-999-9534",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Renaissance Ctr Ste 2600",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482431599",
            "country_code": "US",
            "telephone_number": "313-479-0497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMAGINE MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-392-8679",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovatel Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eun Pyung Philip Im, PHARM.D.
• Jennifer Im, MD
• Subin Im
• Ima Professional Services of PA, PC
• Image Guided Surgery Associates, PC
• Imaging Professionals of Pennsylvania PC (Northeast Imaging)
• Imaging Professionals of Pennsylvania PC (Academy Imaging Center)
• Imaging Professionals of Pennsylvania PC (Callowhill Open MRI)
• Imago Life Counseling, LLC
• Salman Khurshid Imami

• Psychiatry Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.