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, 3 DULLES BUILDING, PHILADELPHIA, PA 19104-4206
(215) 349-8222
Mailing address
3400 SPRUCE ST, 3 DULLES, PHILADELPHIA, PA 19104-4206
(215) 349-8222
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002Y20116
HEALTHNET
PA
05
—
0006610360
—
PA
01
—
0322705000
KEYSTONE
PA
01
—
063598
BLUE SHIELD
PA
01
—
1010509
MERCY
PA
01
—
10706
HEALTHPARTNERS
PA
01
—
273194
MAMSI
PA
01
—
496672
AETNA
PA
01
—
5465605
NJ-MEDICAID
NJ
01
—
CA0235
RR MEDICARE
PA
01
—
G0003165
AMERICHOICE
PA
Enumeration date
08/25/2006
Last updated
11/19/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up