Active NPI
Larry Shusterman, D.O.
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1831292614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OS-006113-L
- Practice address
- 1600 S 28TH St
Philadelphia, PA 19145-1202 - Phone
- (215) 334-1166
- Fax
- (215) 336-1776
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS-006113-L | PA | |
| Internal Medicine Physician | 207R00000X | OS-006113-L | PA | Primary |
Addresses
Primary practice location
1600 S 28TH St
Philadelphia, PA 19145-1202
Mailing address
1600 S 28TH St
Philadelphia, PA 19145-1202
Phone (215) 334-1166
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100326 | Other | PA | KEYSTONE MERCY HEALTH PLA |
| 0080977002 | Other | PA | KEYSTONE HEALTH PLAN EAST |
| 110127288 | Other | PA | PALMETTO GBA |
| 98583 | Other | PA | US HEALTHCARE |
| 4348882 | Other | PA | AETNA |
| 0011417470005 | Medicaid | PA | |
| 0114174702 | Other | PA | AMERICHOICE |
| 6724 | Other | PA | ELDERHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060209000298 | PA | Practitioner - Internal Medicine | 6406861632 | Practice locations: Phila, PA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS-006113-L | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458691200000",
"number": "1831292614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 S 28TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191451202",
"telephone_number": "215-334-1166",
"fax_number": "215-336-1776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 S 28TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191451202",
"telephone_number": "215-334-1166",
"fax_number": "215-336-1776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUSTERMAN",
"first_name": "LARRY",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2016-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS-006113-L",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OS-006113-L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY HEALTH PLA",
"identifier": "100326",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH PLAN EAST",
"identifier": "0080977002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "110127288",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US HEALTHCARE",
"identifier": "98583",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4348882",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011417470005",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "0114174702",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDERHEALTH",
"identifier": "6724",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}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 Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.