RESIDENTIALIST HOUSECALL MED GRP, PC A PENNSYLVANIA CORP
NPI 1104205400
Family Medicine - Geriatric Medicine in Philadelphia, PA

Q: What is Residentialist Housecall Med Grp, PC A Pennsylvania Corp's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Active since May 20, 2015

4190 CITY AVE, PCOM - ROWLAND HALL, ROOM 528, PHILADELPHIA, PA 19131(949) 366-1053(949) 544-7880 Get Directions Write a Review

NPPES record last updated: March 5, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 5, 2025, Aug 1, 2024 (2 updates tracked since 2024).

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About Residentialist Housecall Med Grp, Pc A Pennsylvania Corp NPPES

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

RESIDENTIALIST HOUSECALL MED GRP, PC A PENNSYLVANIA CORP (NPI 1104205400) is a healthcare organization registered as a geriatric medicine in Philadelphia, Pennsylvania and active in the NPI registry since May 2015. The organization lists Marie Walton, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1104205400

Entity TypeOrganization

Primary Taxonomy207QG0300X

Legal Business NameRESIDENTIALIST HOUSECALL MED GRP, PC A PENNSYLVANIA CORP

Location Address4190 CITY AVE, PCOM - ROWLAND HALL, ROOM 528Philadelphia, PA 19131-1626

Mailing Address3800 Kilroy Airport Way Ste 270Long Beach, CA 90806-2497 · (949) 366-1053 · Fax (949) 916-0387

Phone(949) 366-1053

Fax(949) 544-7880

Organization SubpartNo

Authorized OfficialMarie WaltonBilling Manager · (949) 366-1053

Enumeration DateMay 20, 2015

Last NPPES UpdateMarch 5, 20252 updates tracked since enumeration

NPPES CertifiedMarch 5, 2025

✔ NPI 1104205400 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QG0300X

License✔ Licensed in PA · OS017618

Definition

A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.

4190 CITY AVE, Philadelphia, PA 19131

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Residentialist Housecall Med Grp, Pc A Pennsylvania Corp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 14 clinicians reassign Medicare billing to Residentialist Housecall Med Grp, PC A Pennsylvania Corp, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 8 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Nurse Practitioner9

Family Practice2

Internal Medicine2

Geriatric Medicine1

Clinicians, nearest first (14)

Marie Metz, MSN, CRNP, FNP-C

Nurse Practitioner

NPI 1851703508

4190 CITY AVE STE 528
Philadelphia, PA 19131

(215) 849-7700

✔ PECOS✔ Accepts MedicareSame address

Tynisha Davis, FNP-BC

Nurse Practitioner

NPI 1760908123

4190 CITY AVE
Philadelphia, PA 19131

(866) 453-8800

✔ PECOS0.1 mi

Katherine Galluzzi, DO

Geriatric Medicine

NPI 1336140979

4190 CITY AVE SUITE 315
Philadelphia, PA 19131

(215) 871-6844

✔ PECOS✔ Accepts Medicare0.1 mi

Nicol Joseph, DO

Family Practice

NPI 1568494029

4190 CITY AVE SUITE 315
Philadelphia, PA 19131

(215) 871-6844

✔ PECOS✔ Accepts Medicare0.1 mi

Pamela Lewis, CRNP

Nurse Practitioner

NPI 1730408683

801 W GIRARD AVE
Philadelphia, PA 19122

(215) 787-2084

✔ PECOS4.3 mi

Maudeline Paul, NP

Nurse Practitioner

NPI 1720749674

1927 PENFIELD ST
Philadelphia, PA 19138

(267) 244-3944

✔ PECOS5.7 mi

Dana Ridley, MSN, APRN, AGNP-C

Nurse Practitioner

NPI 1699273615

2024 EMILY ST
Philadelphia, PA 19145

(215) 681-1884

✔ PECOS5.8 mi

Jeffrey Maron, DO

Internal Medicine

NPI 1295775963

144 SNYDER AVE
Philadelphia, PA 19148

(215) 336-5566

✔ PECOS6.8 mi

Michael Srulevich, DO

Family Practice

NPI 1275670655

1553 CHESTER PIKE SUITE 201
Crum Lynne, PA 19022

(610) 499-7180

✔ PECOS✔ Accepts Medicare12 mi

Ryan Sholinsky, CRNP

Nurse Practitioner

NPI 1922544923

1113 EASTON RD
Willow Grove, PA 19090

(215) 830-5400

✔ PECOS12 mi

Roxanne Sides, CRNP

Nurse Practitioner

NPI 1174708218

680 BLAIR MILL RD
Horsham, PA 19044

(866) 297-9232

✔ PECOS12 mi

Lauren Kin, CRNP

Nurse Practitioner

NPI 1982481479

1055 WESTLAKES DR STE 3152
Berwyn, PA 19312

(215) 346-6050

✔ PECOS✔ Accepts Medicare14 mi

Benjamin Ware, MD

Internal Medicine

NPI 1073048575

2901 DUTTON MILL RD STE 110
Aston, PA 19014

(610) 485-6700

✔ PECOS✔ Accepts Medicare15 mi

Shvonne Burke, CRNP

Nurse Practitioner

NPI 1447917000

429 4TH AVE FL 7
Pittsburgh, PA 15219

(888) 731-8994

✔ PECOS255 mi

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

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 Residentialist Housecall Med Grp, PC A Pennsylvania Corp's NPI number?

The NPI number for Residentialist Housecall Med Grp, PC A Pennsylvania Corp is 1104205400. It was assigned to this organization in the NPPES registry on May 20, 2015.

Where is Residentialist Housecall Med Grp, PC A Pennsylvania Corp located?

Residentialist Housecall Med Grp, PC A Pennsylvania Corp is located at 4190 City Ave Pcom - Rowland Hall, Room 528, Philadelphia, PA 19131. The listed phone number is (949) 366-1053.

What is Residentialist Housecall Med Grp, PC A Pennsylvania Corp's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Is Residentialist Housecall Med Grp, PC A Pennsylvania Corp enrolled in Medicare?

Yes. Residentialist Housecall Med Grp, PC A Pennsylvania Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Residentialist Housecall Med Grp, PC A Pennsylvania Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 14 clinicians in 4 Medicare specialties reassign their Medicare billing to Residentialist Housecall Med Grp, PC A Pennsylvania Corp. A 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 the clinician's services. The largest specialties are Nurse Practitioner (9), Family Practice (2) and Internal Medicine (2). Of these, 1 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Residentialist Housecall Med Grp, PC A Pennsylvania Corp was last updated on March 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.