Active NPI
Mercy Management of Sepa
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1831189612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- MERCY MANAGEMENT OF SEPA
- Practice address
- 5630 Chestnut St
Philadelphia, PA 19139-3232 - Phone
- (215) 748-3100
- Fax
- (610) 748-1586
- NPI assigned
- Oct 24, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Don Halberstadt
- Title
- Cfo
- Phone
- (610) 567-6964
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
5630 Chestnut St
Philadelphia, PA 19139-3232
Mailing address
1 West Elm Street
2ND Floor
Philadelphia, PA 19482
Phone (610) 567-6964
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA5351 | Other | PA | RAILROAD MEDICARE |
| 1555770 | Other | PA | BLUE SHIELD |
| 30011129 | Other | PA | KEYSTONE MERCY HEALTH PLA |
| 1007787930163 | Medicaid | PA | |
| 18027 | Other | PA | AETNA HMO |
| 2247379000 | Other | PA | KEYSTONE MERCY HEALTH PLA |
| 61258870002 | Other | PA | CIGNA |
| 33699 | Other | PA | HEALTH PARTNERS |
| 5325477 | Other | PA | AETNA PPO |
Other names 1
- Mercy Health Associates
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130112000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1201737600000",
"number": "1831189612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WEST ELM STREET",
"address_2": "2ND FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19482",
"telephone_number": "610-567-6964",
"fax_number": "610-567-6170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5630 CHESTNUT ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191393232",
"telephone_number": "215-748-3100",
"fax_number": "610-748-1586"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERCY MANAGEMENT OF SEPA",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-24",
"last_updated": "2008-01-31",
"status": "A",
"authorized_official_last_name": "HALBERSTADT",
"authorized_official_first_name": "DON",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "610-567-6964",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DA5351",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1555770",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTH PLA",
"identifier": "30011129",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007787930163",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "18027",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTH PLA",
"identifier": "2247379000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "61258870002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "33699",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "5325477",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mercy Health Associates",
"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 Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.