| Dedicated Pennsylvania Holding, Llc | |
|
6431 Sackett St Philadelphia PA 19149-3118 | |
| (305) 628-6117 | |
| (305) 363-5989 |
| Full Name | Dedicated Pennsylvania Holding, Llc |
|---|---|
| Speciality | Specialist |
| Location | 6431 Sackett St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Raymond Jimenez (DIRECTOR OF CLIENT SERVICES) |
| Authorized Official Contact | 7868704039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dedicated Pennsylvania Holding, Llc 1395 N.w/ 167th Street Payer Enrollment Department Miami Gardens FL 33169 Ph: (786) 870-4039 | Dedicated Pennsylvania Holding, Llc 6431 Sackett St Philadelphia PA 19149-3118 Ph: (305) 628-6117 |
| NPI Number | 1477053569 |
|---|---|
| Provider Enumeration Date | 02/15/2018 |
| Last Update Date | 03/27/2018 |
| Medicare PECOS PAC ID | 4688935653 |
|---|---|
| Medicare Enrollment ID | O20180308000694 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477053569 | NPI | - | NPPES |
| Provider Name | Patrick T Waters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356302715 PECOS PAC ID: 6507778826 Enrollment ID: I20031104000436 |
| Provider Name | Rose M Lee |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558334151 PECOS PAC ID: 5193781045 Enrollment ID: I20041202000917 |
| Provider Name | Mark A Oswald |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215935655 PECOS PAC ID: 6800893322 Enrollment ID: I20061026000020 |
| Provider Name | Ellen H Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912069329 PECOS PAC ID: 6901907054 Enrollment ID: I20070719000679 |
| Provider Name | Poonguzhali Pichaimuthu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659567501 PECOS PAC ID: 8628164142 Enrollment ID: I20071015000373 |
| Provider Name | David H Duong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184883308 PECOS PAC ID: 7618049636 Enrollment ID: I20080709000158 |
| Provider Name | Seth R Rubin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235102542 PECOS PAC ID: 8921140435 Enrollment ID: I20100121000681 |
| Provider Name | Courtney A Waters |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730384637 PECOS PAC ID: 1456535848 Enrollment ID: I20110408000495 |
| Provider Name | Mahmud Ali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801001615 PECOS PAC ID: 8123297165 Enrollment ID: I20110809000650 |
| Provider Name | Sumit Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922259431 PECOS PAC ID: 7315118197 Enrollment ID: I20110928000090 |
| Provider Name | Haresh Mohanlal Punjabi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316985906 PECOS PAC ID: 1254508765 Enrollment ID: I20120125000103 |
| Provider Name | Naiema A Benson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730491770 PECOS PAC ID: 7810121308 Enrollment ID: I20131017000048 |
| Provider Name | Latha Cherath |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134446859 PECOS PAC ID: 9032347117 Enrollment ID: I20140117000419 |
| Provider Name | Ephraim Dunn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932536232 PECOS PAC ID: 0749597920 Enrollment ID: I20150921002093 |
| Provider Name | Oleg Grapp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063851103 PECOS PAC ID: 7911201322 Enrollment ID: I20160205000056 |
| Provider Name | Gillian Reid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366843138 PECOS PAC ID: 9638463078 Enrollment ID: I20160809000647 |
| Provider Name | Dillard Elmore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841225554 PECOS PAC ID: 1355355983 Enrollment ID: I20171115003768 |
| Provider Name | Sophie Parker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760416796 PECOS PAC ID: 8426075078 Enrollment ID: I20180417000426 |
| Provider Name | Gordon L Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912108317 PECOS PAC ID: 1456535665 Enrollment ID: I20180606002249 |
| Provider Name | Jessica Elizabeth Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447451851 PECOS PAC ID: 2567500978 Enrollment ID: I20180620002430 |
| Provider Name | Christopher Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740371152 PECOS PAC ID: 3173647492 Enrollment ID: I20180627001340 |
| Provider Name | Susan Schayes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720183254 PECOS PAC ID: 5698806701 Enrollment ID: I20180712001185 |
| Provider Name | Victoria Dawn Cimino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447647516 PECOS PAC ID: 4981953387 Enrollment ID: I20180817002258 |
| Provider Name | Sharda Mukunda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811256019 PECOS PAC ID: 5193957538 Enrollment ID: I20180830002248 |
| Provider Name | Robert T Perkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366892416 PECOS PAC ID: 7113279704 Enrollment ID: I20181009003112 |
| Provider Name | Ardi Hermawan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891267753 PECOS PAC ID: 2668718883 Enrollment ID: I20190109001527 |
| Provider Name | David A Barr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902285653 PECOS PAC ID: 5294024980 Enrollment ID: I20190116003548 |
| Provider Name | Lisa R Keiner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497865497 PECOS PAC ID: 5799686861 Enrollment ID: I20190205000766 |
| Provider Name | Raina Gazurian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619135530 PECOS PAC ID: 1658527130 Enrollment ID: I20190910001121 |
| Provider Name | Peter Rajacic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023351921 PECOS PAC ID: 4981826864 Enrollment ID: I20200226000749 |
| Provider Name | Rohin S Saroya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639529530 PECOS PAC ID: 4082042676 Enrollment ID: I20200313000586 |
| Provider Name | Sameena Kaur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184155343 PECOS PAC ID: 0941631758 Enrollment ID: I20200512000592 |
| Provider Name | Stephen E Stonehouse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285904706 PECOS PAC ID: 8527489020 Enrollment ID: I20200610000214 |
| Provider Name | Indira Alexandra Martinez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821519927 PECOS PAC ID: 3971925710 Enrollment ID: I20200624000004 |
| Provider Name | Mica Natasha Winchester |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982133195 PECOS PAC ID: 8325316573 Enrollment ID: I20200707001589 |
| Provider Name | Darrin Eric Doran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679011647 PECOS PAC ID: 5698044998 Enrollment ID: I20200713003453 |
| Provider Name | Giovanni Domenico Avelluto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700228939 PECOS PAC ID: 1355767963 Enrollment ID: I20200813001123 |
| Provider Name | Kostiya Peki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518975325 PECOS PAC ID: 6608978176 Enrollment ID: I20200908003067 |
| Provider Name | Monica J Lobue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609226752 PECOS PAC ID: 0749516169 Enrollment ID: I20201028000367 |
| Provider Name | Cynthia R Gary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710596481 PECOS PAC ID: 4082024641 Enrollment ID: I20201110002139 |
| Provider Name | Tien Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700361276 PECOS PAC ID: 2961742333 Enrollment ID: I20210128000007 |
| Provider Name | Young Vu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508448192 PECOS PAC ID: 8022417583 Enrollment ID: I20210603000909 |
| Provider Name | Carmen Chinea |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619995941 PECOS PAC ID: 4981661824 Enrollment ID: I20211230001197 |
| Provider Name | Stephanie Amanda Santoro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609026640 PECOS PAC ID: 5092989707 Enrollment ID: I20220324000754 |
| Provider Name | Lisa Abdul-haqq |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982369708 PECOS PAC ID: 7315325230 Enrollment ID: I20220606002265 |
| Provider Name | Owen Morris |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1710405675 PECOS PAC ID: 2062836927 Enrollment ID: I20220929002551 |
| Provider Name | Deborah Niles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376569715 PECOS PAC ID: 3072744143 Enrollment ID: I20221222001159 |
| Provider Name | Kelly Morante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548913973 PECOS PAC ID: 0244603686 Enrollment ID: I20230306000306 |
| Provider Name | Nneka Okeifufe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700470416 PECOS PAC ID: 3779942081 Enrollment ID: I20230705002109 |
| Provider Name | Connor Whitaker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427686344 PECOS PAC ID: 0941660112 Enrollment ID: I20230719002848 |
| Provider Name | Anup K Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700414182 PECOS PAC ID: 7012386592 Enrollment ID: I20230804000562 |
| Provider Name | Caroline Rogi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346771334 PECOS PAC ID: 5496027245 Enrollment ID: I20230913002165 |
| Provider Name | Yao-chieh Cheng |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114546884 PECOS PAC ID: 8527480110 Enrollment ID: I20231006001063 |
| Provider Name | Paras Dhilan Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447830484 PECOS PAC ID: 7012364433 Enrollment ID: I20231107001827 |
| Provider Name | Samantha P D'souza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366068371 PECOS PAC ID: 1355765496 Enrollment ID: I20240104001618 |
| Provider Name | Josephine Nkechi Elumeze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649768185 PECOS PAC ID: 6204275142 Enrollment ID: I20240411003557 |
Laura Yatvin Nutrition Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4231 N. 5th Street, Philadelphia, PA 19140 Phone: 215-455-5370 Fax: 215-455-5374 | |
Center City Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1335 W Tabor Rd, Suite 205, Philadelphia, PA 19141 Phone: 215-924-6210 | |
Solis Physicians Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5800 Ridge Ave, Philadelphia, PA 19128 Phone: 215-487-4692 Fax: 215-487-4274 | |
Health Hero Pa Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 217 Dickinson St, Philadelphia, PA 19147 Phone: 484-667-3382 | |
Vo Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1735 Market St Fl 52, Philadelphia, PA 19103 Phone: 267-314-7252 | |
Rooted Healthcare, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3101 Tyson Ave, Philadelphia, PA 19149 Phone: 917-861-2531 | |
Care Health Partners Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1308 Cottman Ave, Philadelphia, PA 19111 Phone: 732-766-1827 Fax: 609-890-0950 |