Jesse Ryan Victor, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD462116 Issued in PA

Practice address

3998 Red Lion Rd Ste 213
Philadelphia, PA 19114-1440

Phone

(215) 612-5699

NPI assigned

Jun 3, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Neurology

Education

University of Vermont College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Methodist Associates in Healthcare, IncGroup PAC ID 6406755651, 387 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Health- Northeast Hospital, Philadelphia, PA, CCN 390115

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Methodist Associates in Healthcare, Inc

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1053355131

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Methodist Associates in Healthcare, Inc

  • Neurological Surgery Physician
  • Philadelphia, PA
  • NPI 1790390813
  NPD
• Jefferson University Physicians

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1205898723
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jefferson Health - Northeast

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1801963343
  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1851738702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "ROOM 4102",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-265-0239",
            "fax_number": "352-265-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 RED LION RD STE 213",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141440",
            "telephone_number": "215-612-5699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_2": "Room 4102",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103003",
            "country_code": "US",
            "telephone_number": "352-265-0239",
            "fax_number": "352-265-1107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICTOR",
        "first_name": "JESSE",
        "middle_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-03",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "TRN19079",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD462116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosemary Vickers, D.O.
• Jasmine Vickery, MD
• Viclinic PC
• Victor Solon MD PC
• Brett M Victor, M.D.
• Kathleen Ann Victor, RN, MSN, CRNP
• Lourdes Victor
• Mark F Victor, MD
• Skye Victor
• Victori Consulting Services, Inc

• Neurology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Neurology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.