Individual provider Active NPI

Gabriel Clark Stump, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1881431229
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA065608 Issued in PA
Practice address
5501 Old York Rd
Philadelphia, PA 19141-3018
Phone
(215) 456-7890
NPI assigned
Jul 12, 2024
Last updated
Jul 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X OA006880 PA
Medical Physician Assistant 363AM0700X MA065608 PA Primary

Addresses

Primary practice location

5501 Old York Rd
Philadelphia, PA 19141-3018

Mailing address

2201 Pennsylvania Ave Apt 715
Philadelphia, PA 19130-3524
Phone (302) 757-5966

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
I20240906003547 PA Practitioner - Physician Assistant 5597205377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

5501 Old York Rd
Phila, PA 19141-3018

5501 Old York Rd Levy 2
Einstein Pediatrics Associates
Philadelphia, PA 19141-3018
Phone (215) 456-6786

5501 Old York Rd WCB 4TH FLR
Einstein CT Surgery Assoc
Philadelphia, PA 19141-3018
Phone (215) 456-8270

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA065608PAMDMedical Physician Assistant
OA006880PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc CurrentSince Aug 1, 2024 Accepting new patients
Einstein Practice Plan Inc CurrentSince Aug 1, 2024 Accepting new patients
Einstein Practice Plan Inc Past Accepting new patients

Locations

101 E Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 254-2630

5401 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-8220

5501 Old York Rd
#B
Philadelphia, PA 19141
Phone (215) 456-8220

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

5501 York Rd
Philadelphia, PA 19141
Phone (215) 456-7405

Organizations & group practices 4

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 1

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": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1881431229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 PENNSYLVANIA AVE APT 715",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191303524",
            "telephone_number": "302-757-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "215-456-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUMP",
        "first_name": "GABRIEL",
        "middle_name": "CLARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA006880",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA065608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.