NPIMap

Organization Active NPI

Complete Physician Services

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1982659611
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS4457L Issued in PA
Legal business name
COMPLETE PHYSICIAN SERVICES
Practice address
1216 E Hunting Park Ave
Philadelphia, PA 19124
Phone
(215) 533-1333
Fax
(215) 744-4324
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

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

Authorized official

Name
Dr. Kenneth Wiseman, DONPI 1427083849
Title
President
Phone
(215) 533-1333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OS4457L PA Primary

Addresses

Primary practice location

1216 E Hunting Park Ave
Philadelphia, PA 19124

Mailing address

1216 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 533-1333

Other names 1

  • Family Practice Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050421000036 PA Part B Supplier - Clinic/Group Practice 2062450943 Receives reassigned benefits from 5 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

1909 E Washington Ln
#17
Philadelphia, PA 19138

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1982659611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 E HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19124",
            "telephone_number": "215-533-1333",
            "fax_number": "215-744-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 E HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19124",
            "telephone_number": "215-533-1333",
            "fax_number": "215-744-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "WISEMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-533-1333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS4457L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 13, 2014; 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.