Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization
UNIVERSITY OF PENN-MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE L JACKSON (ENROLLMENT LEAD)
(215) 662-6187
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 4 PENN TOWER, PHILADELPHIA, PA 19104-4206
(215) 662-2468
(215) 349-8529
Mailing address
3400 SPRUCE ST, 4 PENN TOWER, PHILADELPHIA, PA 19104-4206
(215) 662-2468
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
PA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y20116
HEALTHNET
PA
05
—
0006610360
—
PA
01
—
0238576000
KEYSTONE
PA
01
—
273544
MAMSI
PA
01
—
30009058
MERCY
PA
01
—
33631
HEALTHPARTNERS
PA
01
—
482524
BLUE SHIELD
PA
01
—
496680
AETNA
PA
05
—
5507103
—
NJ
01
—
CA0235
RR MEDICARE
PA
Enumeration date
09/13/2006
Last updated
11/19/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers