Active NPI
Elena Semprevivo, DDS
- Dentist
- Philadelphia, PA
National Provider Identifier
1992106926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS040086
- Practice address
- 2107 Cottman Avenue
Philadelphia, PA 19149 - Phone
- (215) 235-4060
- NPI assigned
- Sep 9, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS040086 | PA | Primary |
Addresses
Primary practice location
2107 Cottman Avenue
Philadelphia, PA 19149
Mailing address
350 N. Clark Street 6TH Floor
Chicago, IL 60654
Phone (312) 274-4520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160316000830 | FL | Order and Referring Only - Dentist | 2264738343 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS040086 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410220800000",
"number": "1992106926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 N. CLARK STREET 6TH FLOOR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60654",
"telephone_number": "312-274-4520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2107 COTTMAN AVENUE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19149",
"telephone_number": "215-235-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEMPREVIVO",
"first_name": "ELENA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-09",
"last_updated": "2014-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS040086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.