NPIMap

Individual provider Active NPI

Renji Chacko Mathew, CRNA

  • Certified Registered Nurse Anesthetist
  • Philadelphia, PA
National Provider Identifier
1902111669
Registry record updated Mar 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN572530 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 349-8310
NPI assigned
Aug 18, 2010
Last updated
Mar 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN572530 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 349-8310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101214000441 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759578909 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Anesthesia Services PCGroup PAC ID 3173437613, 437 clinicians
Greater Philadelphia Anesthesia Services, PLLCGroup PAC ID 9234539388, 9 clinicians
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

1200 Old York Rd
Abington, PA 19001-3720
Phone (215) 481-2000

225 Wilmington W Chester Pike
Chadds Ford, PA 19317-9011
Phone (215) 701-6780

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

744 W Lancaster Ave
Wayne, PA 19082-2523
Phone (610) 645-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN572530PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 5, 2019 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 5, 2019 Accepting new patients
Greater Philadelphia Anesthesia Services PLLC CurrentSince May 1, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Apr 1, 2016 Accepting new patients
Xenon Anesthesia of Pennsylvania PLLC CurrentSince May 1, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Apr 1, 2016 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Mercy Management of SE PA Nurse Anesthetist, Certified Registered Past Accepting new patients
James F Noone MD PC Past Accepting new patients

Locations

111 Town Square Pl
Ste 420
Jersey City, NJ 07310
Phone (201) 258-4700

225 Wilmington W Chester Pike
Chadds Ford, PA 19317
Phone (833) 728-1368

515 Pennsylvania Ave
Ft Washington, PA 19034
Phone (215) 641-0700

1648 Huntingdon Pike
Meadowbrook, PA 19046
Phone (215) 938-3413

1650 Huntingdon Pike
Ste 313
Meadowbrook, PA 19046
Phone (215) 938-3413

2701 DeKalb Pike
Norristown, PA 19401
Phone (215) 335-6000

1515 Market St
Ste 1200
Philadelphia, PA 19102
Phone (215) 259-8078

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

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

Organizations & group practices 12

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 9

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": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459123200000",
    "number": "1902111669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-349-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-349-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "RENJI",
        "middle_name": "CHACKO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-18",
        "last_updated": "2016-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN572530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.