NPIMap

Organization Active NPI

Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
National Provider Identifier
1841707965
Registry record updated Mar 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DEDICATED PENNSYLVANIA HOLDING, LLC
Practice address
5675 N Front St Ste 141
Philadelphia, PA 19120-2719
Phone
(305) 628-6117
NPI assigned
Jan 10, 2018
Last updated
Mar 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DEDICATED PENNSYLVANIA HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2018

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

Authorized official

Name
Raymond Jimenez
Title
Director of Client Services
Phone
(305) 628-6117

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

5675 N Front St Ste 141
Philadelphia, PA 19120-2719

Mailing address

1395 N.W/ 167TH Street
Payer Enrollment Department
Miami Gardens, FL 33169
Phone (305) 628-6117

Other names 1

  • Dedicated Pennsylvania Olney Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180308000694 PA Part B Supplier - Clinic/Group Practice 4688935653 Receives reassigned benefits from 63 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Dedicated PA Holding LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522108800000",
    "number": "1841707965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 N.W/ 167TH STREET",
            "address_2": "PAYER ENROLLMENT DEPARTMENT",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "33169",
            "telephone_number": "305-628-6117",
            "fax_number": "786-870-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5675 N FRONT ST STE 141",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202719",
            "telephone_number": "305-628-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED PENNSYLVANIA HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED PENNSYLVANIA HOLDING, LLC",
        "enumeration_date": "2018-01-10",
        "last_updated": "2018-03-27",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "DIRECTOR OF CLIENT SERVICES",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Pennsylvania Olney",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.