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JAMES RAPHAEL MD
NPI 1093783581
Orthopaedic Surgery in Philadelphia, PA

Active since March 09, 2006PECOS EnrolledAccepts Medicare Assignment
5501 OLD YORK RD, WILLOWCREST ROAD 4TH FLOOR, PHILADELPHIA, PA 19141(215) 456-7900(215) 456-5948 Get Directions Write a Review

NPPES record last updated: December 19, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About James Raphael Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAMES RAPHAEL MD (NPI 1093783581) is an individual orthopaedic surgery provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (MD049979L) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Albert Einstein Medical Center, and is a graduate of State University Of Ny Upstate Medical University (1988).

NPPES Registry Identity

NPI1093783581
Entity TypeIndividualMale
Primary Taxonomy207X00000X
Provider Legal NameJAMES RAPHAELCredential: MD
Location Address5501 OLD YORK RD, WILLOWCREST ROAD 4TH FLOORPhiladelphia, PA 19141-3018
Mailing AddressPo Box 8500-8735Philadelphia, PA 19178-8735 · (215) 456-7000 · Fax (215) 254-2599
Phone(215) 456-7900
Fax(215) 456-5948
Sole ProprietorNo
Medical School CMSState University Of Ny Upstate Medical UniversityGraduated 1988
Enumeration DateMarch 9, 2006
Last NPPES UpdateDecember 19, 2012
✔ NPI 1093783581 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
License✔ Licensed in PA · MD049979L
Definition
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.
5501 OLD YORK RD, Philadelphia, PA 19141
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Other Identifiers 3

Medicaid001493768PA
Medicare ID-Type Unspecified0000458870
Medicare UPINF91302

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

James Raphael Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325225808
PECOS Enrollment IDI20110609000547
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show James Raphael reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Einstein Practice Plan Inc
Same address
Anatomic Pathology & Clinical Pathology
5501 OLD YORK RD
Phila, PA 19141
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 1,205 clinicians in this Medicare group
NPI 1114970407 (215) 456-6157
Methodist Associates In Health Care, Inc
3.5 mi
Diagnostic Radiology
4900 FRANKFORD AVE
Philadelphia, PA 19124
  • Reassigned Medicare billing, Pennsylvania enrollment
  • Medicare enrollment name: Methodist Associates In Healthcare, Inc
  • 600 clinicians in this Medicare group
NPI 1609417872 (215) 831-2063

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg J0702
This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.
180 services65 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
108 services78 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
39 services39 patients
Injection into tendon or ligament 20550
An injection into a tendon or ligament involves placing medication directly into these areas to help reduce inflammation and pain. It's often used for conditions like arthritis or tendonitis. The procedure is quick and usually involves a local anesthetic.
37 services32 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
26 services24 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
21 services18 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Albert Einstein Medical Center

Acute Care Hospitals · Philadelphia, PA
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390142
Location5501 Old York RoadPhiladelphia, PA 19141 · Philadelphia County
Emergency services Birthing friendly

Abington Memorial Hospital

Acute Care Hospitals · Abington, PA
2/5 CMS rating
OwnershipProprietary
CMS Certification Number390231
Location1200 Old York RoadAbington, PA 19001 · Montgomery County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19141 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$74.47 typical visit price
range $19.30 – $147.29
Typical copayment $18.61 (range $4.82 – $36.82)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH KLECKNER MD
Emergency Medicine
5501 OLD YORK RD, EINSTEIN MEDICAL CENTER - PHILADELPHIA
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-6679
MS. AMMAN HASSAN MD
Pediatrics
5501 OLD YORK RD
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-3810
TAYLOR NICOLE THOMPSON PA-C
Physician Assistant (Medical)
5501 OLD YORK RD, KORMAN BUILDING SUITE 202
PHILADELPHIA, PA 19141
Philadelphia County (215) 254-2630
STEPHEN RYAN CHEN
Orthopaedic Surgery
5501 OLD YORK RD
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-7890
DR. DHRUV SHARMA MD
Student in an Organized Health Care Education/Training Program
5501 OLD YORK RD
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-7890
TIMOTHY DANIEL GARDNER DO
Student in an Organized Health Care Education/Training Program
5501 OLD YORK RD
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-7890
DR. JONATHAN THOMAS LUCIANI DO
Student in an Organized Health Care Education/Training Program
5501 OLD YORK RD
PHILADELPHIA, PA 19141
Philadelphia County (215) 456-7890
ASHIKA KAPOOR MD
Psychiatry & Neurology (Psychiatry)
5501 OLD YORK RD
PHILA, PA 19141
Philadelphia County (215) 456-8103

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is James Raphael's NPI number?

The NPI number for James Raphael is 1093783581. It was assigned to this individual provider in the NPPES registry on March 9, 2006.

Where is James Raphael located?

James Raphael practices at 5501 Old York Rd Willowcrest Road 4th Floor, Philadelphia, PA 19141. The listed phone number is (215) 456-7900.

What is James Raphael's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Is James Raphael enrolled in Medicare?

Yes. James Raphael is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for James Raphael's services?

According to the CMS Revalidation Reassignment List (October 2026 release), James Raphael reassigns Medicare benefits to 2 organizations: Einstein Practice Plan Inc (Phila, PA) and Methodist Associates In Health Care, Inc (Philadelphia, PA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for James Raphael's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does James Raphael accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list James Raphael as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is James Raphael affiliated with any hospitals?

According to CMS data, James Raphael is affiliated with Albert Einstein Medical Center and Abington Memorial Hospital.

When was this NPI record last updated?

The NPPES record for James Raphael was last updated on December 19, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.