Spark TMS Therapeutic Center, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SPARK TMS THERAPEUTIC CENTER, LLC

Practice address

128 Chestnut St Ste 103
Philadelphia, PA 19106-3024

Phone

(484) 278-1616

Fax

(215) 356-1700

NPI assigned

Nov 6, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Andrew PeshekNPI 1255451654

Title

Co-Owner

Phone

(267) 307-2340

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

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

• Andrew Donald Peshek, M.D.

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1255451654
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1982172094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 CHESTNUT ST STE 103",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063024",
            "telephone_number": "484-278-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 CHESTNUT ST STE 103",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063024",
            "telephone_number": "484-278-1616",
            "fax_number": "215-356-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK TMS THERAPEUTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-06",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "PESHEK",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "267-307-2340",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mai Spann-Wilson, LSW
• Kristine V. Spano, PSY.D.
• Nicole Marie Spare, D.O.
• Spark Bird Therapy
• Spark Orthodontics
• Jazmine Sparks
• Taylor Sparks, MA, R-DMT
• David Sparrow Sr.
• Shameka Maria Sparrow, LCSW
• Lora Spasova-Bachvarova, PHARMACIST

• Psychiatry Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; 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.