NPIMap

Individual provider Active NPI

Bruce Paul Kinosian, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1871536177
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD033246E Issued in PA
Practice address
3615 Chestnut St
Room 226
Philadelphia, PA 19104
Phone
(215) 662-2746
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD033246E PA Primary

Addresses

Primary practice location

3615 Chestnut St
Room 226
Philadelphia, PA 19104

Mailing address

3615 Chestnut St
Room 226
Philadelphia, PA 19104-2612

Other identifiers 1

IdentifierTypeStateIssuer
0011721710001MedicaidPA

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
I20090309000099 PA Practitioner - Internal MedicinePractitioner - Geriatric MedicinePractitioner - Hospitalist 1052477528 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Francisco School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, shared by 15 NPIs, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Penn Infusion Therapy
Philadelphia, PA 19104-4206
Phone (215) 662-3285

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD033246EPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Internal Medicine CurrentSince Feb 18, 2009 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 18, 2009 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group Internal Medicine CurrentSince May 1, 2015 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3615 Chestnut St
Philadelphia, PA 19104
Phone (215) 662-2746

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

3615 Chestnut St
Rm 226
Philadelphia, PA 19104
Phone (215) 662-2746

3400 Spruce St
Fl 4
Philadelphia, PA 19104
Phone (215) 662-2050

250 King of Prussia Rd
Radnor, PA 19087
Phone (610) 902-1800

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1871536177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "address_2": "ROOM 226",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "address_2": "ROOM 226",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-2746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINOSIAN",
        "first_name": "BRUCE",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD033246E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011721710001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.