| University Of Penn - Medical Group | |
|
3400 Spruce St 1 Maloney Philadelphia PA 19104-4206 | |
| (215) 662-2300 | |
| Not Available |
| 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 Market St 1 Maloney Bldg Philadelphia PA 19104-3306 Ph: () - | University Of Penn - Medical Group 3400 Spruce St 1 Maloney Philadelphia PA 19104-4206 Ph: (215) 662-2300 |
| NPI Number | 1568579266 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 11/19/2020 |
| Medicare PECOS PAC ID | 6204730955 |
|---|---|
| Medicare Enrollment ID | O20150204001537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568579266 | NPI | - | NPPES |
| 0002Y20116 | Other | PA | HEALTHNET |
| 0346863000 | Other | PA | KEYSTONE |
| 5505101 | Other | NJ | NJ-MEDICAID |
| 1012794 | Other | PA | MERCY |
| 10809 | Other | PA | HEALTHPARTNERS |
| 63533 | Other | PA | BLUE SHIELD |
| CA0235 | Other | PA | RR MEDICARE |
| G00031660 | Other | PA | AMERICHOICE |
| 273188 | Other | PA | MAMSI |
| 496680 | Other | PA | AETNA |
| 0006610360 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Anne M Foley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184620296 PECOS PAC ID: 2769381631 Enrollment ID: I20040108000821 |
| Provider Name | Carrie Marie Burns |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1700988821 PECOS PAC ID: 0345213492 Enrollment ID: I20040817000364 |
| Provider Name | Erika L Tapino |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1295811958 PECOS PAC ID: 3476516386 Enrollment ID: I20041110001049 |
| Provider Name | Nayyar Iqbal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528095437 PECOS PAC ID: 7517905276 Enrollment ID: I20050422000130 |
| Provider Name | Susan J Mandel |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1336176247 PECOS PAC ID: 6507805728 Enrollment ID: I20050427001015 |
| Provider Name | Carissa Sharnetta Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407070501 PECOS PAC ID: 8224136239 Enrollment ID: I20070614000078 |
| Provider Name | Jeremy James Flood |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1639203128 PECOS PAC ID: 5092815092 Enrollment ID: I20070705000019 |
| Provider Name | Megin Adams Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720273543 PECOS PAC ID: 9830284363 Enrollment ID: I20070928000381 |
| Provider Name | Rekha Pandula |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1134183585 PECOS PAC ID: 4587674601 Enrollment ID: I20081021000747 |
| Provider Name | Shannon A Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689819047 PECOS PAC ID: 3072677533 Enrollment ID: I20090127000716 |
| Provider Name | Molly C Carr |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1982766242 PECOS PAC ID: 6800830506 Enrollment ID: I20090514000070 |
| Provider Name | Amitha Padmanabhuni |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1306008818 PECOS PAC ID: 0749335230 Enrollment ID: I20090904000479 |
| Provider Name | Gayle Mitura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336474295 PECOS PAC ID: 2264570712 Enrollment ID: I20091104000051 |
| Provider Name | Julia Kharlip |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1205973203 PECOS PAC ID: 2062573082 Enrollment ID: I20091104000543 |
| Provider Name | Christina M Mitchell |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1932381209 PECOS PAC ID: 8123144946 Enrollment ID: I20100929000362 |
| Provider Name | Caroline S Kim |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1083620322 PECOS PAC ID: 0840297826 Enrollment ID: I20101206000614 |
| Provider Name | Peter J Snyder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255361333 PECOS PAC ID: 4486833878 Enrollment ID: I20110201000733 |
| Provider Name | Anne R Cappola |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1275560559 PECOS PAC ID: 7214119858 Enrollment ID: I20110303000308 |
| Provider Name | James Larry Jameson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1760412811 PECOS PAC ID: 4183536436 Enrollment ID: I20110805000461 |
| Provider Name | Anastassia Amaro |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1013134659 PECOS PAC ID: 5890859466 Enrollment ID: I20111005000094 |
| Provider Name | Raymond E Soccio |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1851456164 PECOS PAC ID: 4385804897 Enrollment ID: I20120320000890 |
| Provider Name | Frances E Love |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588872279 PECOS PAC ID: 5597829010 Enrollment ID: I20120524000305 |
| Provider Name | Mona Al Mukaddam |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1043400567 PECOS PAC ID: 4183888431 Enrollment ID: I20120618000152 |
| Provider Name | Ilona Sinead Lorincz |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083876668 PECOS PAC ID: 4082855804 Enrollment ID: I20130720000137 |
| Provider Name | Caitlin A White |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1285952374 PECOS PAC ID: 9436390903 Enrollment ID: I20130725000381 |
| Provider Name | Melissa Sawyer Falcon |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1689994105 PECOS PAC ID: 6507090180 Enrollment ID: I20131015000855 |
| Provider Name | Alva Vicki Moy Daley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073944104 PECOS PAC ID: 3072741156 Enrollment ID: I20140117000561 |
| Provider Name | Jayme Elizabeth Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578989281 PECOS PAC ID: 0244461549 Enrollment ID: I20140331001136 |
| Provider Name | Kimberly N Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750631016 PECOS PAC ID: 6901057587 Enrollment ID: I20140507000175 |
| Provider Name | Kristen Noelle Kobaly |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1295963148 PECOS PAC ID: 3375768500 Enrollment ID: I20140702001206 |
| Provider Name | Mary Jane Mcdevitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962826255 PECOS PAC ID: 7810113198 Enrollment ID: I20140722001714 |
| Provider Name | Amna Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356531024 PECOS PAC ID: 5395883383 Enrollment ID: I20141111001427 |
| Provider Name | Paige Fortinsky Meizlik |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1801113931 PECOS PAC ID: 1456669092 Enrollment ID: I20151001001997 |
| Provider Name | Amy Silveria Von Sydow Green |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1891169595 PECOS PAC ID: 3375844665 Enrollment ID: I20151210000497 |
| Provider Name | Naji Mohamad Alamuddin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962798900 PECOS PAC ID: 6507156940 Enrollment ID: I20160526001011 |
| Provider Name | Alejandra G Borensztein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699909556 PECOS PAC ID: 1850515024 Enrollment ID: I20160705000309 |
| Provider Name | Patricia O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801245584 PECOS PAC ID: 0345532651 Enrollment ID: I20160707000457 |
| Provider Name | Elizabeth M Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568836245 PECOS PAC ID: 4385931211 Enrollment ID: I20160921000721 |
| Provider Name | Caitlin Leigh Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679096531 PECOS PAC ID: 9234401175 Enrollment ID: I20170828001209 |
| Provider Name | Jessica Wilson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1275824443 PECOS PAC ID: 6002118916 Enrollment ID: I20170920001514 |
| Provider Name | Lori Ann Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760990741 PECOS PAC ID: 1052671377 Enrollment ID: I20180207000105 |
| Provider Name | Mark Saab |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1962711341 PECOS PAC ID: 1850558487 Enrollment ID: I20180918000341 |
| Provider Name | David M Merrick |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1346685062 PECOS PAC ID: 8729330055 Enrollment ID: I20181015000703 |
| Provider Name | Rahaf Sultan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1194131375 PECOS PAC ID: 2365668878 Enrollment ID: I20190919000298 |
| Provider Name | Rachana Mundada |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1023564739 PECOS PAC ID: 3072801877 Enrollment ID: I20210624000496 |
| Provider Name | Jessica Berman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134514672 PECOS PAC ID: 4981999745 Enrollment ID: I20210702002746 |
| Provider Name | Michelle Patricia Walker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780116517 PECOS PAC ID: 0648673244 Enrollment ID: I20210720001857 |
| Provider Name | Jana Havranova Abraham |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1043663966 PECOS PAC ID: 1355634387 Enrollment ID: I20210820000457 |
| Provider Name | Jasmine B Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235717638 PECOS PAC ID: 2062821994 Enrollment ID: I20210915001184 |
| Provider Name | Jacqueline Allred |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902575160 PECOS PAC ID: 2163810458 Enrollment ID: I20211019000210 |
| Provider Name | Maryam Khan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1780893826 PECOS PAC ID: 9931298031 Enrollment ID: I20220910000282 |
| Provider Name | Karen Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295448181 PECOS PAC ID: 8426416835 Enrollment ID: I20230616001071 |
| Provider Name | Rona Raju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366131716 PECOS PAC ID: 9830557818 Enrollment ID: I20230623000345 |
| Provider Name | Heather Muller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821772104 PECOS PAC ID: 5496116295 Enrollment ID: I20230726001931 |
| Provider Name | Rachel Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821777921 PECOS PAC ID: 0941657795 Enrollment ID: I20231115003475 |
| Provider Name | Patricia Yea Chu |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1881048601 PECOS PAC ID: 1951694389 Enrollment ID: I20240510001701 |
| Provider Name | Javier Ocampo-mascaro |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1366930513 PECOS PAC ID: 9436692589 Enrollment ID: I20240618002144 |
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