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1700 S Broad St Apt 201 Philadelphia PA 19145-2340 | |
| (215) 685-1803 | |
| (215) 685-1815 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 S Broad St Apt 201, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Christine Gaddy (BILLING MANAGER) |
| Authorized Official Contact | 2156856843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
500 S Broad St Fl 2 Information & Reimbursement Philadelphia PA 19146-1613 Ph: (215) 685-6863 | 1700 S Broad St Apt 201 Philadelphia PA 19145-2340 Ph: (215) 685-1803 |
| NPI Number | 1942317094 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 11/25/2019 |
| Medicare PECOS PAC ID | 6305758723 |
|---|---|
| Medicare Enrollment ID | O20040220000911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942317094 | NPI | - | NPPES |
| 1000076950098 | Medicaid | PA | |
| G0002730 | Medicaid | PA | |
| 16792 | Medicaid | PA | |
| 1002859 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Pennsylvania) | Primary |
| Provider Name | Helena Akua Kwakwa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366550345 PECOS PAC ID: 7517868169 Enrollment ID: I20040116000179 |
| Provider Name | Mary P Eschelman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295848364 PECOS PAC ID: 1658272893 Enrollment ID: I20040120000283 |
| Provider Name | Rita Eburuoh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114030483 PECOS PAC ID: 3274428032 Enrollment ID: I20040219000647 |
| Provider Name | Blessy Methikalam |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396709952 PECOS PAC ID: 9133114960 Enrollment ID: I20040420000081 |
| Provider Name | Shashi R Divaker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275646218 PECOS PAC ID: 2668463944 Enrollment ID: I20040524001360 |
| Provider Name | Kathleen C Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184773129 PECOS PAC ID: 4082680582 Enrollment ID: I20040907000702 |
| Provider Name | Anthony P Milicia |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1861408155 PECOS PAC ID: 4284601758 Enrollment ID: I20040914000617 |
| Provider Name | Millen W Gebreselassie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275646234 PECOS PAC ID: 9537124482 Enrollment ID: I20041119001002 |
| Provider Name | Victor J Igbokidi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1548262009 PECOS PAC ID: 1658336623 Enrollment ID: I20041201000687 |
| Provider Name | Esther Cindy Lendor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063469831 PECOS PAC ID: 1759295520 Enrollment ID: I20050124000875 |
| Provider Name | James Dean |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972515625 PECOS PAC ID: 3476504994 Enrollment ID: I20050202000309 |
| Provider Name | Janet Elizabeth Romano |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1649219445 PECOS PAC ID: 9830141175 Enrollment ID: I20050215000981 |
| Provider Name | Leslie B Mayro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003829508 PECOS PAC ID: 3971543851 Enrollment ID: I20050510000885 |
| Provider Name | Yelena Galkin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457363723 PECOS PAC ID: 8820031669 Enrollment ID: I20050602001142 |
| Provider Name | Karen May Trabulsi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831202332 PECOS PAC ID: 5294771754 Enrollment ID: I20050706000644 |
| Provider Name | Sean F Scott |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306859822 PECOS PAC ID: 6406871235 Enrollment ID: I20051011000859 |
| Provider Name | Ngozi V Onuoha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700832953 PECOS PAC ID: 2062477847 Enrollment ID: I20051017001020 |
| Provider Name | Leena Vadaketh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396743787 PECOS PAC ID: 1052391158 Enrollment ID: I20051104000718 |
| Provider Name | Issy C Esangbedo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1871606939 PECOS PAC ID: 7113925710 Enrollment ID: I20061115000001 |
| Provider Name | Karen W Rendulich |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134132566 PECOS PAC ID: 0840298485 Enrollment ID: I20061115000274 |
| Provider Name | Laura A. Hribar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265445613 PECOS PAC ID: 3476551011 Enrollment ID: I20061115000276 |
| Provider Name | Julie S Cherian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306959309 PECOS PAC ID: 5496859449 Enrollment ID: I20070330000259 |
| Provider Name | Leslie A Cheeseman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467569079 PECOS PAC ID: 0042315079 Enrollment ID: I20070419000116 |
| Provider Name | Tanya D Malone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124136007 PECOS PAC ID: 5193823987 Enrollment ID: I20070601000141 |
| Provider Name | Roy Hoffman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396935052 PECOS PAC ID: 5890691588 Enrollment ID: I20070730000191 |
| Provider Name | Sarah E Messick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093728420 PECOS PAC ID: 8628160520 Enrollment ID: I20070823000393 |
| Provider Name | Cindy Kuo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083658256 PECOS PAC ID: 2668459199 Enrollment ID: I20070829000007 |
| Provider Name | Deepthi R Foxhall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720115280 PECOS PAC ID: 1658468111 Enrollment ID: I20071030000598 |
| Provider Name | Elizabeth A Wenger |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023286788 PECOS PAC ID: 0648354548 Enrollment ID: I20080303000300 |
| Provider Name | Norma H Carandang Panis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1275610651 PECOS PAC ID: 7113002783 Enrollment ID: I20080306000198 |
| Provider Name | Janel E Hackney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154542843 PECOS PAC ID: 7012094378 Enrollment ID: I20080410000443 |
| Provider Name | Stacey Parker Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952560583 PECOS PAC ID: 8022163930 Enrollment ID: I20090828000187 |
| Provider Name | Esther D Chernak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467785824 PECOS PAC ID: 1355481565 Enrollment ID: I20091221000083 |
| Provider Name | Diane L Zameska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962738765 PECOS PAC ID: 7618003286 Enrollment ID: I20100407000679 |
| Provider Name | James W Shepard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447284856 PECOS PAC ID: 7618004706 Enrollment ID: I20100421000690 |
| Provider Name | Mina E Mark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588999585 PECOS PAC ID: 5294865259 Enrollment ID: I20100617000656 |
| Provider Name | Eileen F Pargola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881856003 PECOS PAC ID: 7113051673 Enrollment ID: I20100819000137 |
| Provider Name | Matthew Man |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891954731 PECOS PAC ID: 5799800819 Enrollment ID: I20100914000112 |
| Provider Name | Charlotta A.m. Swain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043394190 PECOS PAC ID: 0840315842 Enrollment ID: I20100914001158 |
| Provider Name | Susan R Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790906840 PECOS PAC ID: 7012109440 Enrollment ID: I20101006000061 |
| Provider Name | Neena Rachel Winter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619113404 PECOS PAC ID: 3375731763 Enrollment ID: I20101229000869 |
| Provider Name | Sharon Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356406151 PECOS PAC ID: 1850589250 Enrollment ID: I20110103000108 |
| Provider Name | Alan Magner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245436575 PECOS PAC ID: 7810186970 Enrollment ID: I20110105001136 |
| Provider Name | Keimah W Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861713935 PECOS PAC ID: 4981893682 Enrollment ID: I20110112000102 |
| Provider Name | Patricia A Daniels |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1841308293 PECOS PAC ID: 5799965737 Enrollment ID: I20110209000274 |
| Provider Name | Erin Pusz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659519056 PECOS PAC ID: 4385825033 Enrollment ID: I20110301000139 |
| Provider Name | Sharon B Carey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700898301 PECOS PAC ID: 7416131263 Enrollment ID: I20110404000202 |
| Provider Name | Jane B Fritz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902020266 PECOS PAC ID: 4981889631 Enrollment ID: I20110425000349 |
| Provider Name | Vladimir S Perelshteyn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144233917 PECOS PAC ID: 3476738980 Enrollment ID: I20110427000485 |
| Provider Name | Khudsiya S Khan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629186069 PECOS PAC ID: 5698950830 Enrollment ID: I20110503000353 |
| Provider Name | Haseeda A Salam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336152537 PECOS PAC ID: 3274718366 Enrollment ID: I20110505000472 |
| Provider Name | Susan Ragonesi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467419192 PECOS PAC ID: 8224214234 Enrollment ID: I20110509000463 |
| Provider Name | Malti Damani |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063447266 PECOS PAC ID: 2961688924 Enrollment ID: I20110510000062 |
| Provider Name | Cyrilene A Eastmond |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326151341 PECOS PAC ID: 9234315169 Enrollment ID: I20110511000015 |
| Provider Name | Nino Vittorio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710990239 PECOS PAC ID: 4789860644 Enrollment ID: I20110511000244 |
| Provider Name | V Blake Marshall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952341992 PECOS PAC ID: 3779769518 Enrollment ID: I20110512000420 |
| Provider Name | Manette K Fine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194769034 PECOS PAC ID: 3476582016 Enrollment ID: I20110518000312 |
| Provider Name | Patricia C Sandiford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033210455 PECOS PAC ID: 1456537646 Enrollment ID: I20110524000690 |
| Provider Name | Lisa J Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336282953 PECOS PAC ID: 9830126432 Enrollment ID: I20110526000198 |
| Provider Name | Ramona Chube |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023121019 PECOS PAC ID: 2365628450 Enrollment ID: I20110526000238 |
| Provider Name | Lewis M Albert |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1639156201 PECOS PAC ID: 0143348300 Enrollment ID: I20110526000670 |
| Provider Name | Deborah E. Hoellein |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699788182 PECOS PAC ID: 1355528399 Enrollment ID: I20110531000634 |
| Provider Name | Kundabula Joshi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1619080967 PECOS PAC ID: 6507043411 Enrollment ID: I20110601000815 |
| Provider Name | Karen Duckworth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417969908 PECOS PAC ID: 7810174414 Enrollment ID: I20110608000337 |
| Provider Name | Betty Jane Gilbert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912015983 PECOS PAC ID: 6305023722 Enrollment ID: I20110610000336 |
| Provider Name | Cynthia R Venegas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902819428 PECOS PAC ID: 0840478020 Enrollment ID: I20110620000004 |
| Provider Name | Lokadri N Raminani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720191356 PECOS PAC ID: 2567630353 Enrollment ID: I20110721000664 |
| Provider Name | Anna Pak |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295830685 PECOS PAC ID: 2062441579 Enrollment ID: I20110811000028 |
| Provider Name | Fatema Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790796068 PECOS PAC ID: 0941479448 Enrollment ID: I20110817000369 |
| Provider Name | Mira M Gohel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306859806 PECOS PAC ID: 8426229964 Enrollment ID: I20110914000271 |
| Provider Name | Gerard T Hart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295843357 PECOS PAC ID: 4880860832 Enrollment ID: I20111222000348 |
| Provider Name | Valerie A Bonica |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184885329 PECOS PAC ID: 9638345366 Enrollment ID: I20111230000486 |
| Provider Name | Sharon Lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154579241 PECOS PAC ID: 6800050261 Enrollment ID: I20120614000518 |
| Provider Name | Rachael S Truchil |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1093949737 PECOS PAC ID: 4284898693 Enrollment ID: I20120615000231 |
| Provider Name | Maureen C Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538397294 PECOS PAC ID: 2264697689 Enrollment ID: I20120709000555 |
| Provider Name | Letitia Price |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841426509 PECOS PAC ID: 9931355443 Enrollment ID: I20120815000410 |
| Provider Name | Roberta I Vena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881957280 PECOS PAC ID: 3870744816 Enrollment ID: I20121121000319 |
| Provider Name | Josephine K Lappia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700025806 PECOS PAC ID: 5395904189 Enrollment ID: I20130618000483 |
| Provider Name | Lisa A Maslankowski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750300240 PECOS PAC ID: 3971746983 Enrollment ID: I20130823000303 |
| Provider Name | Nichelle Adegbite-maraventano |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891003208 PECOS PAC ID: 8123262011 Enrollment ID: I20130916000188 |
| Provider Name | Sarah N Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649595380 PECOS PAC ID: 9335383702 Enrollment ID: I20130925000467 |
| Provider Name | Jeannette A Mighty |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801011374 PECOS PAC ID: 0244457802 Enrollment ID: I20140806000453 |
| Provider Name | Ehidiamen A Anetor-jamison |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588892608 PECOS PAC ID: 2062647274 Enrollment ID: I20141002000603 |
| Provider Name | Barbara F. Westerhaus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679868376 PECOS PAC ID: 5991925109 Enrollment ID: I20141009001159 |
| Provider Name | Ravi Nagraj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609163815 PECOS PAC ID: 2062634199 Enrollment ID: I20141105001422 |
| Provider Name | Rebecka Ly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841583416 PECOS PAC ID: 7517280936 Enrollment ID: I20141216000740 |
| Provider Name | Leila S Hardware |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780844571 PECOS PAC ID: 9739343096 Enrollment ID: I20141218000873 |
| Provider Name | Mayssa M Abuali |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023273943 PECOS PAC ID: 8426376773 Enrollment ID: I20150416000960 |
| Provider Name | Heather L Medica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073866760 PECOS PAC ID: 2860633484 Enrollment ID: I20150421000755 |
| Provider Name | Sadonna Major |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477952679 PECOS PAC ID: 4486973088 Enrollment ID: I20150504000628 |
| Provider Name | Eileen S Donaghy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376657585 PECOS PAC ID: 8527389543 Enrollment ID: I20150603000310 |
| Provider Name | Erin Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245529460 PECOS PAC ID: 4385950690 Enrollment ID: I20150901002937 |
| Provider Name | Kathryn P Miller |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174880702 PECOS PAC ID: 9335457357 Enrollment ID: I20150924001673 |
| Provider Name | John W Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184683468 PECOS PAC ID: 0749269322 Enrollment ID: I20151005002968 |
| Provider Name | Lacondria F Simmons |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659751436 PECOS PAC ID: 6507166857 Enrollment ID: I20151118002474 |
| Provider Name | Mini Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194102277 PECOS PAC ID: 5496057150 Enrollment ID: I20160112002138 |
| Provider Name | Bindu Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508284910 PECOS PAC ID: 0648573113 Enrollment ID: I20160119000163 |
| Provider Name | Meredith Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841691094 PECOS PAC ID: 6103047311 Enrollment ID: I20160211000306 |
| Provider Name | Ambily Pailo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043664246 PECOS PAC ID: 2668762824 Enrollment ID: I20160601001032 |
| Provider Name | Phyillis S Yang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649573171 PECOS PAC ID: 9335433572 Enrollment ID: I20160810001389 |
| Provider Name | Zarna D Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407268980 PECOS PAC ID: 9436443447 Enrollment ID: I20160812001256 |
| Provider Name | Gina Steinberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871956185 PECOS PAC ID: 8022303619 Enrollment ID: I20160822001345 |
| Provider Name | Alison Beth Mcgrorty Crotts |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093158255 PECOS PAC ID: 7719208057 Enrollment ID: I20160909002052 |
| Provider Name | Kaitlin S Merritt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063879260 PECOS PAC ID: 4486933652 Enrollment ID: I20161110000692 |
| Provider Name | Jennifer A Oshea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609230945 PECOS PAC ID: 1759663891 Enrollment ID: I20170125000018 |
| Provider Name | Rachel Sugarman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487099461 PECOS PAC ID: 1759687189 Enrollment ID: I20170223001434 |
| Provider Name | Siu-kuen Azor Hui |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336685916 PECOS PAC ID: 7416231519 Enrollment ID: I20170309002393 |
| Provider Name | Emily C Ramsey North |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417271131 PECOS PAC ID: 4789960980 Enrollment ID: I20170424000112 |
| Provider Name | Christine Grace Giordano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861802811 PECOS PAC ID: 0749409282 Enrollment ID: I20170714001040 |
| Provider Name | Daniel Chung |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891113585 PECOS PAC ID: 7315160322 Enrollment ID: I20170825000118 |
| Provider Name | Charlene Lai |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598177172 PECOS PAC ID: 4183841638 Enrollment ID: I20170901000126 |
| Provider Name | Mark I Bur |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326561184 PECOS PAC ID: 8729352398 Enrollment ID: I20170920001488 |
| Provider Name | Shun Yu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821418211 PECOS PAC ID: 5092096990 Enrollment ID: I20170928002632 |
| Provider Name | Kimberly H Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144532748 PECOS PAC ID: 5092932228 Enrollment ID: I20171017001255 |
| Provider Name | Stacy Ann T Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265953723 PECOS PAC ID: 1759647753 Enrollment ID: I20171107003439 |
| Provider Name | Megan L Crofford-hotz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457801185 PECOS PAC ID: 8022378868 Enrollment ID: I20180215002658 |
| Provider Name | Leeann Tanaka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760801898 PECOS PAC ID: 1355568544 Enrollment ID: I20180501000062 |
| Provider Name | Christin C Mulholland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366959587 PECOS PAC ID: 4880941939 Enrollment ID: I20180719002446 |
| Provider Name | Jasmine A Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144712258 PECOS PAC ID: 4587912183 Enrollment ID: I20180730001253 |
| Provider Name | Aleka Kostouros |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851769327 PECOS PAC ID: 1658620356 Enrollment ID: I20180814000467 |
| Provider Name | Teiah M Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033520929 PECOS PAC ID: 3173874948 Enrollment ID: I20180919000275 |
| Provider Name | Victoria L Webb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447670153 PECOS PAC ID: 6103178603 Enrollment ID: I20181011000554 |
| Provider Name | Parisa M Garrett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891850756 PECOS PAC ID: 0840397717 Enrollment ID: I20181024000746 |
| Provider Name | Tawanaha Stokes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891251609 PECOS PAC ID: 7810239597 Enrollment ID: I20190429002004 |
| Provider Name | Robert Pileggi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356790695 PECOS PAC ID: 0446588784 Enrollment ID: I20190823000981 |
| Provider Name | Saajid Musheno King |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285289355 PECOS PAC ID: 2668704412 Enrollment ID: I20191028001178 |
| Provider Name | Jacqueline Sweeney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154893303 PECOS PAC ID: 6800228727 Enrollment ID: I20191114003221 |
| Provider Name | Jasmine Joy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851866792 PECOS PAC ID: 5294169645 Enrollment ID: I20191218001735 |
| Provider Name | Jinho Yoo |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1780065144 PECOS PAC ID: 5698109437 Enrollment ID: I20200102001566 |
| Provider Name | Javier Miguel De Jesus Orpi |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629120605 PECOS PAC ID: 4880858661 Enrollment ID: I20200121000209 |
| Provider Name | Andrea A Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053952150 PECOS PAC ID: 9537585112 Enrollment ID: I20200806000183 |
| Provider Name | Jovana Loncarevic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265891139 PECOS PAC ID: 2062832207 Enrollment ID: I20201009000208 |
| Provider Name | Andrea Silver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124635818 PECOS PAC ID: 4981013802 Enrollment ID: I20210505003099 |
| Provider Name | Mabel A Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215504238 PECOS PAC ID: 6608277082 Enrollment ID: I20210623000038 |
| Provider Name | Su Aye |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518459809 PECOS PAC ID: 4880938851 Enrollment ID: I20211011001445 |
| Provider Name | Viergina L Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164990909 PECOS PAC ID: 7214333566 Enrollment ID: I20211108002649 |
| Provider Name | Sarah Sherman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366995466 PECOS PAC ID: 0446643258 Enrollment ID: I20220131000392 |
| Provider Name | Jillian E Gansert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568992626 PECOS PAC ID: 8426442450 Enrollment ID: I20220308001245 |
| Provider Name | Meera Chatterjee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669968707 PECOS PAC ID: 2163800319 Enrollment ID: I20220601000509 |
| Provider Name | Maggie Ross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013641018 PECOS PAC ID: 4981086998 Enrollment ID: I20220806000393 |
| Provider Name | Nicholas Froehlich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467907147 PECOS PAC ID: 0446632442 Enrollment ID: I20220808003380 |
| Provider Name | Diyong S Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144820622 PECOS PAC ID: 1355723255 Enrollment ID: I20220808003426 |
| Provider Name | Katelyn V Brendel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174017875 PECOS PAC ID: 1951784834 Enrollment ID: I20220810003549 |
| Provider Name | Tahir Thomas Kinsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811494065 PECOS PAC ID: 4486909470 Enrollment ID: I20220921000838 |
| Provider Name | Natalie Genoveva Robiou |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144663287 PECOS PAC ID: 9032415641 Enrollment ID: I20221207002649 |
| Provider Name | Corey Kenneth Cramer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801243555 PECOS PAC ID: 3971890955 Enrollment ID: I20230109002921 |
| Provider Name | Rebecca Alms |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912494071 PECOS PAC ID: 7012382286 Enrollment ID: I20230401000031 |
| Provider Name | Benjamin D Krempley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518520279 PECOS PAC ID: 8426382516 Enrollment ID: I20230921003506 |
| Provider Name | Animisha Kommera |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770102626 PECOS PAC ID: 8224575816 Enrollment ID: I20240731003360 |
| Provider Name | Meghan Mcdonald |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649808783 PECOS PAC ID: 9032656517 Enrollment ID: I20240801002311 |
| Provider Name | Anne C Agre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518580539 PECOS PAC ID: 8527505726 Enrollment ID: I20240806002431 |
| Provider Name | Barbara Porter |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1245491919 PECOS PAC ID: 7416138359 Enrollment ID: I20240808003147 |
| Provider Name | Lauren L Hughes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063972552 PECOS PAC ID: 3274990585 Enrollment ID: I20240809000047 |
| Provider Name | Chederli Belongilot |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255952388 PECOS PAC ID: 2264979145 Enrollment ID: I20240809000735 |
Laura Yatvin Nutrition Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4231 N. 5th Street, Philadelphia, PA 19140 Phone: 215-455-5370 Fax: 215-455-5374 | |
Health Hero Pa Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 217 Dickinson St, Philadelphia, PA 19147 Phone: 484-667-3382 | |
Vo Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1735 Market St Fl 52, Philadelphia, PA 19103 Phone: 267-314-7252 | |
Rooted Healthcare, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3101 Tyson Ave, Philadelphia, PA 19149 Phone: 917-861-2531 | |
Care Health Partners Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1308 Cottman Ave, Philadelphia, PA 19111 Phone: 732-766-1827 Fax: 609-890-0950 | |
University Of Penn - Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3400 Spruce St, 3 Ravdin, Suite F, Pulmonary & Critical Care, Philadelphia, PA 19104 Phone: 215-662-3202 | |