Philadelphia Family Medicne Assoc P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS009019L Issued in PA

Legal business name

PHILADELPHIA FAMILY MEDICNE ASSOC P.C.

Practice address

1028 W Oregon Ave
Philadelphia, PA 19148-4421

Phone

(215) 389-7766

Fax

(215) 389-0227

NPI assigned

May 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Joseph P Direnzo Jr., D.O.NPI 1811991292

Title

President

Phone

(215) 389-7766

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CGJGAD
• Direct secure messaging: pfma@directaddress.net

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph P Direnzo Jr., DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1811991292
  Medicare reassignment Care Compare group NPD Authorized official
• Marc A Matozzo, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1437156098
  Medicare reassignment Care Compare group NPD
• Joseph D. Norris, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
  • NPI 1346247905
  Medicare reassignment Care Compare group
• Shannon Lee Rakitis, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
  • NPI 1508751264
  Medicare reassignment NPD
• Mariah Amber Jones, PA-C

  • Physician Assistant
  • Philadelphia, PA
  • NPI 1093226797
  Medicare reassignment
• Ryan Scott Rafferty, PA-C

  • Surgical Physician Assistant
  • Haddon Heights, NJ
  • NPI 1710581798

  PA

  Medicare reassignment

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1912958638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 W OREGON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191484421",
            "telephone_number": "215-389-7766",
            "fax_number": "215-389-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 W OREGON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191484421",
            "telephone_number": "215-389-7766",
            "fax_number": "215-389-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA FAMILY MEDICNE ASSOC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "DIRENZO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-389-7766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009019L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015771060001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pfma@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1028 W Oregon Ave",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191484421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.