| University Of Penn-medical Group | |
|
3400 Spruce St 4 Penn Tower Philadelphia PA 19104-4206 | |
| (215) 662-2468 | |
| (215) 349-8529 |
| Full Name | University Of Penn-medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 3400 Spruce St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Chante L Jackson (ENROLLMENT LEAD) |
| Authorized Official Contact | 2156626187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of Penn-medical Group 3400 Spruce St 4 Penn Tower Philadelphia PA 19104-4206 Ph: (215) 662-2468 | University Of Penn-medical Group 3400 Spruce St 4 Penn Tower Philadelphia PA 19104-4206 Ph: (215) 662-2468 |
| NPI Number | 1477658599 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 11/19/2020 |
| Medicare PECOS PAC ID | 6204730955 |
|---|---|
| Medicare Enrollment ID | O20141204000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477658599 | NPI | - | NPPES |
| 496680 | Other | PA | AETNA |
| 0238576000 | Other | PA | KEYSTONE |
| 30009058 | Other | PA | MERCY |
| 5507103 | Medicaid | NJ | |
| CA0235 | Other | PA | RR MEDICARE |
| 0002Y20116 | Other | PA | HEALTHNET |
| 273544 | Other | PA | MAMSI |
| 33631 | Other | PA | HEALTHPARTNERS |
| 0006610360 | Medicaid | PA | |
| 482524 | Other | PA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Pennsylvania) | Primary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (Pennsylvania) | Secondary |
| Provider Name | Monica E Luchi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1417983925 PECOS PAC ID: 6608834957 Enrollment ID: I20050103000769 |
| Provider Name | Nora B Sandorfi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1578583332 PECOS PAC ID: 1759333156 Enrollment ID: I20050214000780 |
| Provider Name | Chris Terry Derk |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1609899210 PECOS PAC ID: 5890747232 Enrollment ID: I20050215000109 |
| Provider Name | Frederick T Murphy |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1205834397 PECOS PAC ID: 3274553672 Enrollment ID: I20051130000574 |
| Provider Name | Androniki Bili |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1104802719 PECOS PAC ID: 1850311143 Enrollment ID: I20060922000050 |
| Provider Name | Chadwick Rudolph Johr |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1134144660 PECOS PAC ID: 8325043573 Enrollment ID: I20060922000183 |
| Provider Name | Jonathan S Dunham |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1376583310 PECOS PAC ID: 9234173832 Enrollment ID: I20061009000156 |
| Provider Name | David Abraham Allan |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1376518233 PECOS PAC ID: 9537262340 Enrollment ID: I20070316000023 |
| Provider Name | Sally W Pullman Mooar |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1912930702 PECOS PAC ID: 9335212331 Enrollment ID: I20080724000332 |
| Provider Name | Steffan W Schulz |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1316154487 PECOS PAC ID: 2466504246 Enrollment ID: I20090709000520 |
| Provider Name | Marissa Blum |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1316080229 PECOS PAC ID: 0143373639 Enrollment ID: I20090731000012 |
| Provider Name | Joshua F Baker |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1396808937 PECOS PAC ID: 8426189200 Enrollment ID: I20100622000693 |
| Provider Name | Geo S Derimanov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932135407 PECOS PAC ID: 0749304632 Enrollment ID: I20100830000393 |
| Provider Name | Sharon Kolasinski |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1912943044 PECOS PAC ID: 4385769421 Enrollment ID: I20100914000316 |
| Provider Name | Joan M Von Feldt |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1689600199 PECOS PAC ID: 0648395798 Enrollment ID: I20100914000452 |
| Provider Name | Elizabeth C Hsia |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1457373300 PECOS PAC ID: 6608991450 Enrollment ID: I20100916000549 |
| Provider Name | Anupama V Shahane |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1447424320 PECOS PAC ID: 4385837772 Enrollment ID: I20101018001061 |
| Provider Name | Michael R Rudnick |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1790719664 PECOS PAC ID: 0941300388 Enrollment ID: I20101019001278 |
| Provider Name | Preethi Thomas |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811937857 PECOS PAC ID: 2466645296 Enrollment ID: I20101025000579 |
| Provider Name | Frederick B Vivino |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1952337339 PECOS PAC ID: 2466640891 Enrollment ID: I20101229000208 |
| Provider Name | David J Chang |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1902838295 PECOS PAC ID: 0941489439 Enrollment ID: I20110131000377 |
| Provider Name | Alexis R Ogdie-beatty |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1871657882 PECOS PAC ID: 0648458596 Enrollment ID: I20110624000387 |
| Provider Name | Peter A Merkel |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1437136173 PECOS PAC ID: 9830135292 Enrollment ID: I20120123000561 |
| Provider Name | Michael D George |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104002039 PECOS PAC ID: 8123281623 Enrollment ID: I20120521000268 |
| Provider Name | Antoine G Sreih |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1629001730 PECOS PAC ID: 8527062967 Enrollment ID: I20130705000005 |
| Provider Name | Sheilagh Mary Mccauley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336575679 PECOS PAC ID: 0648405027 Enrollment ID: I20131022000322 |
| Provider Name | Rennie Rhee |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1669649935 PECOS PAC ID: 8628292158 Enrollment ID: I20140624000432 |
| Provider Name | Colin Ligon |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1316180540 PECOS PAC ID: 6002070125 Enrollment ID: I20160701000333 |
| Provider Name | Annemarie Schorpion |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1326302621 PECOS PAC ID: 8022383371 Enrollment ID: I20171012000917 |
| Provider Name | Sara Dana Wasserman |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1992930408 PECOS PAC ID: 9436373487 Enrollment ID: I20171026000185 |
| Provider Name | Stephanie Lynne Giattino |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1598008666 PECOS PAC ID: 6406110725 Enrollment ID: I20180514000582 |
| Provider Name | Ethan Craig |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1316239874 PECOS PAC ID: 3274765243 Enrollment ID: I20180906000027 |
| Provider Name | Naomi Ann Amudala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154655348 PECOS PAC ID: 7911041355 Enrollment ID: I20190122000573 |
| Provider Name | Shubhasree Banerjee |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1285994640 PECOS PAC ID: 9032351341 Enrollment ID: I20190725003620 |
| Provider Name | Meghan Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326577867 PECOS PAC ID: 0042633075 Enrollment ID: I20200709002788 |
| Provider Name | Joelle Koplin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730456005 PECOS PAC ID: 5395039044 Enrollment ID: I20201020000780 |
| Provider Name | Dana Direnzo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144563164 PECOS PAC ID: 4284932617 Enrollment ID: I20210520000041 |
| Provider Name | Jonathan Miner |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1639480528 PECOS PAC ID: 3476782061 Enrollment ID: I20210723000240 |
| Provider Name | Thomas Roberts Riley |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1841794450 PECOS PAC ID: 2264781483 Enrollment ID: I20210728000655 |
| Provider Name | Kimberly Dequattro |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1295096873 PECOS PAC ID: 1759633316 Enrollment ID: I20210806002373 |
| Provider Name | Nikhil Jiwrajka |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1497095236 PECOS PAC ID: 9830475623 Enrollment ID: I20220420000805 |
| Provider Name | Sokratis Apostolidis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518353317 PECOS PAC ID: 1355656273 Enrollment ID: I20220524002441 |
| Provider Name | Ian Cooley |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1457887770 PECOS PAC ID: 2365710035 Enrollment ID: I20220810001200 |
| Provider Name | Rachel Dayno |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1063943355 PECOS PAC ID: 1355768292 Enrollment ID: I20230629002502 |
| Provider Name | Nam Nguyen |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1770902744 PECOS PAC ID: 5597066019 Enrollment ID: I20240517002069 |
| Provider Name | Ellen Elizabeth Romich |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1619437308 PECOS PAC ID: 0345783916 Enrollment ID: I20240624004067 |
| Provider Name | Jonathan Kotzin |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1821557166 PECOS PAC ID: 9638613664 Enrollment ID: I20240702001289 |
| Provider Name | Gelareh Atefi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1700190956 PECOS PAC ID: 1850698648 Enrollment ID: I20241009002090 |
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 | |