Individual provider Active NPI

Roger A Fons, MD

  • Pediatric Anesthesiology Physician
  • Philadelphia, PA
National Provider Identifier
1831266352
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
License
MD482663 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(215) 590-1000
Fax
(215) 590-1415
NPI assigned
Nov 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36927 WI
Pediatric Anesthesiology Physician 207LP3000X MD482663 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

3401 Civic Center Blvd Ste 9329
Philadelphia, PA 19104-4319
Phone (267) 425-9300

Other identifiers 2

IdentifierTypeStateIssuer
3235500MedicaidWI
1831266352MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101101001202 WI Practitioner - Anesthesiology 1456545698 Reassigns benefits to 1 organization
I20240221001252 PA Practitioner - Anesthesiology 1456545698 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36927WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Anesthesiology Associates, LTD Pediatric Anesthesiology CurrentSince Jan 8, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. Family Medicine CurrentSince Aug 1, 2010 Accepting new patients
Children'S Anesthesiology Associates, LTD Pediatric Anesthesiology CurrentSince Jan 8, 2024 Accepting new patients

Locations

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1831266352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD STE 9329",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "267-425-9300",
            "fax_number": "267-443-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1000",
            "fax_number": "215-590-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONS",
        "first_name": "ROGER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "36927",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "PA",
            "license": "MD482663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3235500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831266352",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.