Individual provider Active NPI

John Henry Ignatiev, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1932764412
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD478166 Issued in PA
Practice address
2301 S Broad St
Philadelphia, PA 19148-3542
Phone
(617) 699-9055
NPI assigned
May 9, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD478166 PA Primary

Addresses

Primary practice location

2301 S Broad St
Philadelphia, PA 19148-3542

Mailing address

2031 S Broad St
Philadelphia, PA 19148-5505

Other practice location 1

20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220628001522 PA Practitioner - Internal Medicine 1850625609 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD478166PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc Internal Medicine CurrentSince Jul 1, 2022 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jul 1, 2022 Accepting new patients

Locations

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

2301 S Broad St
Philadelphia, PA 19148
Phone (215) 952-9000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1932764412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191485505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191483542",
            "telephone_number": "617-699-9055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103220",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IGNATIEV",
        "first_name": "JOHN",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-09",
        "last_updated": "2022-12-12",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD478166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.