PA Surgery Group LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

PA SURGERY GROUP LLC

Practice address

2200 Arch St Ste 102
Philadelphia, PA 19103-1353

Phone

(215) 515-2881

NPI assigned

Aug 4, 2023

Last updated

Aug 26, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ali Mohammad, DDSNPI 1952557852

Title

Surgeon

Phone

(917) 330-0939

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 6

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.

• Ali Ebrahim Mohammad, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
  • NPI 1952557852
  Medicare reassignment NPD Authorized official
• Sean Sangmin Kim

  • Dentist
  • Philadelphia, PA
  • NPI 1477182467
  Medicare reassignment NPD
• Logan Davis Rutch, DMD, MMS

  • Dentist
  • Philadelphia, PA
  • NPI 1366021040
  NPD
• Kevin Jay Cross, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Wayne, PA
  • NPI 1144436403
  NPD (past)
• Aneesh Gupta, M.D.

  • Obstetrics & Gynecology Physician
  • Philadelphia, PA
  • NPI 1669821245
  NPD (past)
• Lisa S Kyriakatos, PA-C

  • Physician Assistant
  • Philadelphia, PA
  • NPI 1831277177
  NPD (past)

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

{
    "created_epoch": "1691107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1891477162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 ARCH ST STE 102",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031353",
            "telephone_number": "215-515-2881",
            "fax_number": "267-715-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 ARCH ST STE 102",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031353",
            "telephone_number": "215-515-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PA SURGERY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-04",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A",
        "authorized_official_last_name": "MOHAMMAD",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "SURGEON",
        "authorized_official_telephone_number": "917-330-0939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gladys Paasewe, MSN, CRNP, PMHNP-BC
• Umar Pabon, CEO
• Susan Pacana, CRNA

• Oral and Maxillofacial Surgery (Dentist) in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.