Individual provider Active NPI

Mary Katherine Tonetti, PA-C

  • Surgical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1861964439
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2156623830 Issued in PA
Practice address
3400 Spruce St
2 Dulles
Philadelphia, PA 19104-4238
Phone
(215) 662-3830
NPI assigned
Dec 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2156623830 PA Primary

Addresses

Primary practice location

3400 Spruce St
2 Dulles
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
2 Dulles
Philadelphia, PA 19104-4238
Phone (215) 662-3830

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190115000795 PA Practitioner - Physician Assistant 0840536751 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2156623830PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jan 7, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Jan 7, 2019 Accepting new patients

Locations

3400 Spruce St
Fl 5
Philadelphia, PA 19104
Phone (215) 662-2777

3400 Spruce St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-2428

Organizations & group practices 3

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": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1861964439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "2 DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "2 DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TONETTI",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "2156623830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.