Individual provider Active NPI

Bryn Marie Carroll, MD

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1831512136
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD467043 Issued in PA
Practice address
3401 Civic Boulevard
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104-4399
Phone
(215) 590-1000
NPI assigned
Jan 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD467043 PA Primary

Addresses

Primary practice location

3401 Civic Boulevard
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104-4399

Mailing address

3401 Civic Boulevard, 9NW Room 55
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104-4399
Phone (215) 590-1220

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200804000653 PA Practitioner - Pediatric Medicine 2163847450 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD467043PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childen'S Health Care Associates Inc. CurrentSince Jul 1, 2020 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Jul 1, 2020 Accepting new patients
Childrens Hospital of Philadelphia Past Accepting new patients

Locations

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

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

Organizations & group practices 4

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": "1390435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1831512136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC BOULEVARD, 9NW ROOM 55",
            "address_2": "THE CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044399",
            "telephone_number": "215-590-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC BOULEVARD",
            "address_2": "THE CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044399",
            "telephone_number": "215-590-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "BRYN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-23",
        "last_updated": "2024-03-25",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD467043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.