NPIMap

University of Penn-Medical Group

Organization Active NPI Hospitalist Physician · Philadelphia, PA

NPI 1992301196 · NPPES record last updated Dec 21, 2020

Key facts

NPI
1992301196
Entity type
Organization (NPI type 2)
Primary specialty
Hospitalist Physician 208M00000X
Legal business name
UNIVERSITY OF PENN-MEDICAL GROUP
Practice address
501 S 54TH St
Philadelphia, PA 19143-1900
Phone
(215) 748-9707
NPI assigned
Dec 11, 2020
Organization subpart
No

Authorized official

Name
Chante L Jackson
Title
Enrollment Lead
Phone
(215) 662-6187

Other NPIs on the same Medicare enrollment 50

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 50

Practitioners 79

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

View all 79

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in PA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20141111000091 PA Part B Supplier - Clinic/Group Practice 6204730955 Receives reassigned benefits from 3,792 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20150304001436 PA Part B Supplier - Clinic/Group Practice 6204730955 Receives reassigned benefits from 818 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Radnor, PA; Radnoe, PA; Philadelphia, PA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208M00000X Yes

Addresses

Primary practice location

501 S 54TH St
Philadelphia, PA 19143-1900

Mailing address

PO Box 824320
Philadelphia, PA 19182-4320
Phone (215) 762-0810

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 21, 2020.

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1992301196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824320",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824320",
            "telephone_number": "215-762-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S 54TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191431900",
            "telephone_number": "215-748-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF PENN-MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHANTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ENROLLMENT LEAD",
        "authorized_official_telephone_number": "215-662-6187"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

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Sources for this page

Verify at the official NPI Registry.