University Of Penn - Medical Group, NPI 1497767495
Geriatric Medicine (Internal Medicine) Physician in Philadelphia, PA, US
NPI number: what is it?
The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...
| NPI | 1497767495 |
| NPI Entity Type | Organization |
| Provider Name | University Of Penn - Medical Group |
| Enumeration Date | September 30, 2009 |
| Last Update Date | September 30, 2009 |
| Certification Date | September 30, 2009 |
| Provider Location Address | 3615 Chestnut St, Ralston-penn Center, Philadelphia, PA, US |
| Provider Mailing Address | 3615 Ralston Center, Ralston Penn Center, Philadelphia, PA, US, 191042612 |
| Gender | Male |
| Is Sole Proprietor? | No |
Organization Official
| Official Name | Chante L Jackson |
| Official Position | ENROLLMENT LEAD |
| Phone | 215-662-6187 |
Group Taxonomy
| Taxonomy Code | 193200000X |
| Taxonomy Name | 193200000X MULTI-SPECIALTY GROUP |
| Definition | A business group of one or more individual practitioners, who practice with different areas of specialization. |
Primary Taxonomy
| Taxonomy Code | |
| Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician |
| Classification | |
| Group | |
| Description | An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
Secondary Taxonomies
| Taxonomy Code | Group | Classification | License No. | State | Primary? |
|---|---|---|---|---|---|
| No | |||||
| No | |||||
| No |
Other Identifiers
| Identifier | Identifier State | Identifier Issuer | Type/Code |
|---|---|---|---|
| 1010530 | PA | MERCY | 01 |
| CA0235 | PA | RR MEDICARE | 01 |
| 496703 | PA | AETNA | 01 |
| 0006610360 | PA | MEDICAID | 05 |
| 5466407 | NJ | NJ-MEDICAID | 01 |
| 11192 | PA | HEALTH PARTNERS | 01 |
| 0002Y20116 | PA | HEALTHNET | 01 |
| 0270301000 | PA | KEYSTONE | 01 |
| 043052 | PA | BLUE SHIELD | 01 |
| 273211 | PA | MAMSI | 01 |
| G0005268 | PA | AMERICHOICE | 01 |
Health Information Exchange
| Endpoint Type | Endpoint | Description | Use | Content Type | Affiliation | Location |
|---|---|---|---|---|---|---|
| CONNECT | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | 2.16.840.1.113883.3.1068.1 | OTHER | Yes | 2720 Dundee Rd # 302, Northbrook, IL, US |
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|---|---|---|---|
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MD Christopher Michael Smith Individual |
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MS. BCBA Tatyana Brandi-rae Washington Individual |
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DR. PSYD Jayna Burleigh Individual |
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MD Yehuda Lebowicz Individual |
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Samantha Tsuchiya Individual |
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RDN, LDN Katherine L Armstrong Individual |
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Lycorx Llc Organization |
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