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Contact Information

UNIVERSITY OF PENN-MEDICAL GROUP
3400 SPRUCE ST
3 SILVERSTEIN BUILDING, SUITE D
PHILADELPHIA, PA19104-4206
 Phone: 215-662-6932
 Fax: 215-662-7899
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Infectious Disease

207RI0200X 11 Physician/Internal Medicine
 

Pediatric Infectious Diseases

2080P0208X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for UNIVERSITY OF PENN-MEDICAL GROUP

NPI Number 1194832899
LBN Legal business name UNIVERSITY OF PENN-MEDICAL GROUP
Authorized official CHANTE JACKSON - (ENROLLMENT LEAD)
Entity Organization
Organization subpart 1 No
Enumeration date 08/25/2006
Last updated 11/19/2020 - About 6 years ago
Identifiers
PA Medicaid 0006610360
PA Other 496686 AETNA
PA Other G00048530 AMERICHOICE
PA Other 043054 BLUE SHIELD
PA Other 0002Y20116 HEALTHNET
PA Other 10724 HEALTHPARTNERS
PA Other 0345789000 KEYSTONE
PA Other 273224 MAMSI
PA Other 1010882 MERCY
PA Other 5467403 NJ-MEDICAID
PA Other CA0235 RR MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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