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TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Complete NPI Record 1114031036
Internal Medicine - Gastroenterology in Radnor, PA

NPI Status: Active since August 18, 2006

Contact Information

250 KING OF PRUSSIA RD
RADNOR, PA
ZIP 19087
Phone: (610) 902-5600

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Authorized Official Last Name
  21. Authorized Official First Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Other Provider Identifier 1
  27. Other Provider Identifier Type Code 1
  28. Other Provider Identifier State 1
  29. Other Provider Identifier Issuer 1
  30. Other Provider Identifier 2
  31. Other Provider Identifier Type Code 2
  32. Other Provider Identifier State 2
  33. Other Provider Identifier Issuer 2
  34. Other Provider Identifier 3
  35. Other Provider Identifier Type Code 3
  36. Other Provider Identifier State 3
  37. Other Provider Identifier Issuer 3
  38. Other Provider Identifier 4
  39. Other Provider Identifier Type Code 4
  40. Other Provider Identifier State 4
  41. Other Provider Identifier 5
  42. Other Provider Identifier Type Code 5
  43. Other Provider Identifier State 5
  44. Other Provider Identifier Issuer 5
  45. Other Provider Identifier 6
  46. Other Provider Identifier Type Code 6
  47. Other Provider Identifier State 6
  48. Other Provider Identifier Issuer 6
  49. Other Provider Identifier 7
  50. Other Provider Identifier Type Code 7
  51. Other Provider Identifier State 7
  52. Other Provider Identifier Issuer 7
  53. Other Provider Identifier 8
  54. Other Provider Identifier Type Code 8
  55. Other Provider Identifier State 8
  56. Other Provider Identifier Issuer 8
  57. Is Organization Subpart
  58. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1114031036. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1114031036
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 3624 MARKET ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 560W
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: PHILADELPHIA
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: PA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 191042614
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2156622286
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 250 KING OF PRUSSIA RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: RADNOR
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: PA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 190875220
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6109025600
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/18/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 1/6/2014
The date that a record was last updated or changed.
Authorized Official Last Name: JOHNSTON
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ELIZABETH
The first name of the authorized official.
Authorized Official Title or Position: EXECUTIVE DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 2156627583
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RG0100X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 0211219000
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: PA
Other Provider Identifier Issuer 1: KEYSTONE
Other Provider Identifier 2: 2Y21509
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: PA
Other Provider Identifier Issuer 2: HEALTHNET
Other Provider Identifier 3: CN3127
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: PA
Other Provider Identifier Issuer 3: RR MEDICARE
Other Provider Identifier 4: 1001258770
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: PA
Other Provider Identifier 5: 17588
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: PA
Other Provider Identifier Issuer 5: HEALTHPARTNERS
Other Provider Identifier 6: 536910
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: PA
Other Provider Identifier Issuer 6: BLUE SHIELD
Other Provider Identifier 7: 707804
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: PA
Other Provider Identifier Issuer 7: AETNA
Other Provider Identifier 8: 1038515
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: PA
Other Provider Identifier Issuer 8: MERCY
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP