DEDICATED PENNSYLVANIA HOLDING, LLC (NPI# 1952804312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952804312 |
| Entity Type | Organization |
| Organization Name | DEDICATED PENNSYLVANIA HOLDING, LLC |
| Other Organization Name | DEDICATED PENNSYLVANIA NORTH PHILADELPHIA |
| Practice Address |
2101 W Lehigh Ave Ste A Philadelphia PA 19132-2664 |
| Mailing Address |
1395 N.w. 167th Street Payer Enrollment Department Miami Gardens FL 33169 |
| Practice Telephone | 3056286117 |
| Practice Fax Number | 7868704039 |
| Mailing Telephone | 7868704039 |
| Mailing Fax Number | 7868704039 |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2018-03-13 |
| Authorized Official Name | MR. RAYMOND JIMENEZ (DIR OF CLIENT SVCS) |
| Authorized Official Telephone | 7868704039 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEDICATED PENNSYLVANIA HOLDING, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | Other Service Providers | ||
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 332900000X | Non-Pharmacy Dispensing Site | Suppliers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Dedicated Pennsylvania North Philadelphia | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023655602 | Dedicated Pennsylvania Holding, LLC | Non-Pharmacy Dispensing Site | 330 W Oregon Ave # 170, Philadelphia, PA 19148-4723 | 2019-12-03 |
| 1366950776 | Dedicated Pennsylvania Holding, LLC | Clinic/Center | 5675 N. Front Strreet, Suite 141, Philadelphia, PA 19120-1910 | 2018-01-19 |
| 1942703137 | Dedicated Pennsylvania Holding, LLC | Specialist | 1575 N 52nd St Ste S-3, Philadelphia, PA 19131-4736 | 2018-03-14 |
| 1477053569 | Dedicated Pennsylvania Holding, LLC | Internal Medicine | 6431 Sackett St, Philadelphia, PA 19149-3118 | 2018-02-15 |
| 1841707965 | Dedicated Pennsylvania Holding, LLC | Family Medicine | 5675 N Front St Ste 141, Philadelphia, PA 19120-2719 | 2018-01-10 |
| Street Address |
2101 W LEHIGH AVE STE A |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19132-2664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356302715 | Patrick Timothy Waters | Family Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2006-03-28 |
| 1891267753 | Ardi Hermawan | Nurse Practitioner | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2018-12-17 |
| 1982133195 | Mica Natasha Winchester | Internal Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2017-06-09 |
| 1932536232 | Ephraim Dunn | Family Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132 | 2013-10-01 |
| 1811256019 | Sharda Mukunda | Internal Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2012-05-08 |
| 1730491770 | Naiema A Benson | Internal Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2010-07-07 |
| 1518975325 | Kostiya Kana Peki | Internal Medicine | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2006-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811511017 | Irene Maria Clark | Social Worker | 3101 N. 29th St., Philadelphia, PA 19132 | 2020-06-03 |
| 1518407519 | Forget Me Knot Youth Services | Residential Treatment Facility, Emotionally Disturbed Children | 2321 N Broad Street, Philadelphia, PA 19132 | 2017-02-24 |
| 1609322437 | Shaakira Gillette | Social Worker | 2514 N. Broad St, Philadelphia, PA 19132 | 2016-08-31 |
| 1578017042 | Education Plus, Inc. | Nurse Practitioner | 3217 W. Clearfield Street, Philadelphia, PA 19132 | 2016-08-12 |
| 1972958544 | Rittenhouse Health LLC | Substance Abuse Rehabilitation Facility | 2321 N. Broad St, Philadelphia, PA 19132 | 2016-05-02 |
| 1336593458 | Jamal Vann | Counselor | 2233-43 West Allegheny Avenue, Philadelphia, PA 19132 | 2016-04-14 |
| 1487027132 | Jazzmin Devine | Specialist/Technologist | 200 Prospect St Hemlock 430a, East Stroudsburg University, PA 19132 | 2015-11-03 |
| 1609282508 | Lawrence Petitfrere | Pharmacist | 2801 W Dauphin St, Philadelphia, PA 19132 | 2014-07-11 |
| 1437565157 | Mental Health Partnerships | Community/Behavioral Health | 2709 N. Broad Street, Philadelphia, PA 19132 | 2014-07-02 |
| 1477977346 | Randy Morman | Counselor | 2514 N. Broad Street, 1st Floor, Philadelphia, PA 19132 | 2014-02-12 |
| Find all providers in zip 19132 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427674407 | Jun Song | Internal Medicine | 3401 N Broad St Ste 801, Philadelphia, PA 19140-5103 | 2020-06-24 |
| 1932725264 | Aaron Leo Yazdian | Internal Medicine | 1335 South St Apt A, Philadelphia, PA 19147-1841 | 2020-06-23 |
| 1144846387 | Rishabh Khatri | Internal Medicine | 322 N Broad St Apt 1523, Philadelphia, PA 19102-1122 | 2020-06-23 |
| 1215564521 | Insight Home Physicians, PC | Internal Medicine | 7806 Cresheim Rd, Philadelphia, PA 19118-4003 | 2020-03-25 |
| 1457995938 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 3401 Market St Ste 105b, Philadelphia, PA 19104-3315 | 2019-10-29 |
| 1205479904 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 219 N Broad St 8fl, Philadelphia, PA 19107-1507 | 2019-10-25 |
| 1700439056 | Alvaro Goncalves Mendes Neto | Internal Medicine | 5501 Old York Rd # 363, Philadelphia, PA 19141-3018 | 2019-07-16 |
| 1720648223 | Ali Haydar | Internal Medicine | 245 N. 15th St, 6th Floor, Ms 42, Philadelphia, PA 19102 | 2019-06-17 |
| 1114587672 | Stephen Michael Pokrywa | Internal Medicine | Drexel University Com, Internal Medicine Residency, 245 N. 15th St., 6th Floor, Ms 427, Philadelphia, PA 19102-1178 | 2019-06-17 |
| 1124688734 | Aakash Patel | Internal Medicine | Drexel University College of Medicine-internal Medicine, 245 N. 15th St. 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-17 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19132 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.