NPIMap

Individual provider Active NPI

Christine V Soutendijk, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1912958224
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD062781L Issued in PA
Practice address
700 Walnut St FL 2
Philadelphia, PA 19106
Phone
(215) 503-4779
Fax
(215) 503-4922
NPI assigned
May 12, 2006
Last updated
Sep 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

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 MD062781L PA Primary

Addresses

Primary practice location

700 Walnut St FL 2
Philadelphia, PA 19106

Mailing address

700 Walnut St FL 2
Philadelphia, PA 19106-3505
Phone (215) 503-4779

Other practice location 1

211 S 9th St
Walnut Towers, Suite 401
Philadelphia, PA 19107-6810
Phone (215) 503-4779

Other identifiers 2

IdentifierTypeStateIssuer
0016979910006MedicaidPA
001697991MedicaidPA

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
I20050208000474 PA Practitioner - Internal Medicine 0941251870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

833 Chestnut St E
7TH FLR Suite 701
Philadelphia, PA 19107-5102
Phone (215) 955-6180

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Internal Medicine CurrentSince Feb 1, 2014 Accepting new patients
Jefferson University Physicians Internal Medicine CurrentSince Feb 1, 2014 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

211 S 9th St
Ste 401
Philadelphia, PA 19107
Phone (215) 440-8681

700 Walnut St
Fl 2
Philadelphia, PA 19106
Phone (215) 503-4779

833 Chestnut St
Ste 701
Philadelphia, PA 19107
Phone (215) 955-0735

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 3

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 4

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1912958224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063505",
            "telephone_number": "215-503-4779",
            "fax_number": "215-503-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19106",
            "telephone_number": "215-503-4779",
            "fax_number": "215-503-4922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 S 9th St",
            "address_2": "Walnut Towers, Suite 401",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191076810",
            "country_code": "US",
            "telephone_number": "215-503-4779",
            "fax_number": "215-503-4922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTENDIJK",
        "first_name": "CHRISTINE",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD062781L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016979910006",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001697991",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.