Individual provider Active NPI

John Andrew Ridge, M.D.

  • Surgical Oncology Physician
  • Philadelphia, PA
National Provider Identifier
1841212008
Registry record updated Apr 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
MD045188L Issued in PA
Practice address
333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434
Phone
(215) 728-6900
Fax
(215) 728-2773
NPI assigned
Jul 24, 2006
Last updated
Apr 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD045188L PA
Surgical Oncology Physician 2086X0206X MD045188L PA Primary

Addresses

Primary practice location

333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 728-6900

Other identifiers 1

IdentifierTypeStateIssuer
0012530730001MedicaidPA

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
I20100608000486 PA Practitioner - General SurgeryPractitioner - Otolaryngology 6103956784 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD045188LPAMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Apr 1, 2021 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Apr 1, 2021 Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients
Health Services of Fox Chase Cancer Center Past Accepting new patients

Locations

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

7500 Central Ave
Ste 209
Philadelphia, PA 19111
Phone (215) 725-7600

1077 Rydal Rd
Rydal, PA 19046
Phone (215) 707-7300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1841212008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-728-6900",
            "fax_number": "215-728-2773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-6900",
            "fax_number": "215-728-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDGE",
        "first_name": "JOHN",
        "middle_name": "ANDREW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD045188L",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "PA",
            "license": "MD045188L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012530730001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.