NPIMap

Organization Active NPI

Philadelphia College of Osteopathic Medicine

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1881635704
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Practice address
4190 City Ave
Philadelphia, PA 19131-1626
Phone
(215) 871-6562
Fax
(215) 871-6781
NPI assigned
Jun 10, 2006
Last updated
Sep 13, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Authorized official

Name
Kenneth J Veit, DONPI 1104827286
Title
Sr VP for Academic Affairs and Dean
Phone
(215) 871-6562

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Psychologist 103T00000X NU
Neuromusculoskeletal Medicine & OMM Physician 204D00000X NU
Family Medicine Physician 207Q00000X NU Primary
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU
Internal Medicine Physician 207R00000X NU
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU
Pulmonary Disease Physician 207RP1001X NU
Orthopaedic Surgery Physician 207X00000X NU
Pediatrics Physician 208000000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

4190 City Ave
Philadelphia, PA 19131-1626

Mailing address

PO Box 22383
New York, NY 10087-2383
Phone (215) 871-6562

Other identifiers 2

IdentifierTypeStateIssuer
1007772030027MedicaidPA
CC3119OtherPARAIL ROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040114000179 PA Part B Supplier - Clinic/Group Practice 0648179234 Receives reassigned benefits from 31 practitioners
Practice locations: Philadelphia, PA
O20090507000012 PA Part B Supplier - Clinic/Group Practice 0648179234 Receives reassigned benefits from 3 practitioners
Practice locations: Philadelphia, PA
O20121016000690 GA Part B Supplier - Clinic/Group Practice 0648179234 Receives reassigned benefits from 4 practitioners
Practice locations: Suwanee, GA

National Provider Directory

National Provider Directory
Part of
Pcom-Family Medical Cen

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

625 Old Peachtree Rd NW
Ste 104
Suwanee, GA 30024
Phone (678) 225-7485

200 Monument Rd
#S10
Bala Cynwyd, PA 19004
Phone (215) 654-3066

2204 W Cambria St
Philadelphia, PA 19132
Phone (215) 226-6525

4148 Lancaster Ave
Philadelphia, PA 19104
Phone (215) 662-0119

4150 City Line Ave
Philadelphia, PA 19131
Phone (215) 871-2600

4190 City Ave
Ste 509
Philadelphia, PA 19131
Phone (215) 871-6941

4190 City Line Ave
Ste 320
Philadelphia, PA 19131
Phone (215) 871-1871

4190 City Line Ave
Ste 330
Philadelphia, PA 19131
Phone (215) 871-6337

4190 City Line Ave
Ste 777
Philadelphia, PA 19131
Phone (215) 871-6380

5830 Henry Ave
Philadelphia, PA 19128
Phone (215) 483-2300

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Temple Health - Chestnut Hill HospitalPhiladelphia, PA, CCN 390026 Hospital 5% Or Greater Indirect Ownership Interest (20%) May 3, 2022
Temple Health - Chestnut Hill HospitalPhiladelphia, PA, CCN 39S026 Hospital 5% Or Greater Indirect Ownership Interest (20%) May 3, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1881635704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22383",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100872383",
            "telephone_number": "215-871-6562",
            "fax_number": "215-871-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 CITY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311626",
            "telephone_number": "215-871-6562",
            "fax_number": "215-871-6781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE",
        "enumeration_date": "2006-06-10",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "VEIT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR VP FOR ACADEMIC AFFAIRS AND DEAN",
        "authorized_official_telephone_number": "215-871-6562",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007772030027",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CC3119",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.