NPIMap

Individual provider Active NPI

Konstantin V Chernukha, M.D.

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1861576530
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD419155 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-7237
Fax
(215) 707-9389
NPI assigned
Oct 25, 2006
Last updated
Aug 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X C1-0010427 DE
Diagnostic Radiology Physician 2085R0202X D0073496 MD
Diagnostic Radiology Physician 2085R0202X MD419155 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-7237

Other practice location 1

2401 West Belvedere Ave
Baltimore, MD 21215
Phone (410) 601-5339

Other practice location 2

333 Cottman Ave
Philadelphia, PA 19111-2434
Phone (215) 728-3883

Other practice location 3

2401 West Belvedere Ave
Baltimore, MD 21215
Phone (410) 601-5339

Other identifiers 2

IdentifierTypeStateIssuer
MD419155OtherPAMEDICAL LICENSE
D0073496OtherMDLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929000430 PA Practitioner - Diagnostic Radiology 1850360504 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3326

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0073496MDMDDiagnostic Radiology Physician
MD419155PAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Mar 6, 2019 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 6, 2019 Accepting new patients
Rittenhouse Imaging Center, LLC Diagnostic Radiology CurrentSince May 1, 2013 Accepting new patients
Jeanes Radiology Associates LLC Diagnostic Radiology CurrentSince May 1, 2013 Accepting new patients
Lebanon Diagnostic Imaging, LLC Diagnostic Radiology PastSince Apr 6, 2009 Accepting new patients
Insight Health Corp Past Accepting new patients
Delaware Open MRI Radiology Associates LLC Diagnostic Radiology Past Accepting new patients
Univ of Penn Community Radiology Diagnostic Radiology Past Accepting new patients
Wilkes Barre Imaging, LLC Diagnostic Radiology PastSince Oct 1, 2009 Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients
Indiana University Radiology Associates, Inc. Diagnostic Radiology Past Accepting new patients

Locations

150 E Pennsylvania Ave
Downingtown, PA 19335
Phone (215) 772-9674

2365 Heritage Center Dr
Furlong, PA 18925
Phone (215) 728-3883

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

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

11000 Roosevelt Blvd
Philadelphia, PA 19116
Phone (215) 214-6655

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

2301 E Allegheny Ave
Philadelphia, PA 19134
Phone (215) 282-8000

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

Organizations & group practices 11

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1861576530",
    "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": "215-707-7237",
            "fax_number": "215-707-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-7237",
            "fax_number": "215-707-9389"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 West Belvedere Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "21215",
            "country_code": "US",
            "telephone_number": "410-601-5339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Cottman Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112434",
            "country_code": "US",
            "telephone_number": "215-728-3883",
            "fax_number": "215-728-1185",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2401 West Belvedere Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "21215",
            "country_code": "US",
            "telephone_number": "410-601-5339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHERNUKHA",
        "first_name": "KONSTANTIN",
        "middle_name": "V",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "DE",
            "license": "C1-0010427",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D0073496",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD419155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD419155",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "D0073496",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.