Dedicated Pennsylvania Holding, LLC
NPI 1477053569ActiveOrganization· Specialist· Philadelphia, PA
Specialist in Philadelphia, Pennsylvania, registered in NPPES in February 2018, part of Dedicated Pennsylvania Mayfair. The authorized official on file is Raymond Jimenez, Director Of Client Services. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1477053569 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Dedicated Pennsylvania Mayfair |
| NPI issued | Feb 15, 2018 |
| Last updated in NPPES | Mar 27, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | — | — |
| Internal Medicine | 207R00000X | — | — |
| Clinic/Center, Primary Care | 261QP2300X | — | — |
| Non-Pharmacy Dispensing Site | 332900000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (PA) |
|---|
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