DEDICATED PENNSYLVANIA MAYFAIR
NPI 1477053569
Specialist in Philadelphia, PA

Q: What is Dedicated Pennsylvania Holding, LLC's NPI number?

The NPI number for Dedicated Pennsylvania Holding, LLC is 1477053569. It was assigned to this organization in the NPPES registry on February 15, 2018. The provider is doing business as Dedicated Pennsylvania Mayfair.

Q: What is Dedicated Pennsylvania Holding, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since February 15, 2018

6431 SACKETT ST, PHILADELPHIA, PA 19149(305) 628-6117(305) 363-5989 Get Directions Write a Review

NPPES record last updated: March 27, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 27, 2018, Feb 15, 2018 (2 updates tracked since 2018).

On this page

About Dedicated Pennsylvania Mayfair NPPES

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

DEDICATED PENNSYLVANIA MAYFAIR (NPI 1477053569) is a healthcare organization registered as a specialist in Philadelphia, Pennsylvania and active in the NPI registry since February 2018. The organization lists Raymond Jimenez, Director Of Client Services, as its authorized official.

NPPES Registry Identity

NPI1477053569

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameDEDICATED PENNSYLVANIA HOLDING, LLC

Location Address6431 SACKETT STPhiladelphia, PA 19149-3118

Mailing Address1395 N.w/ 167th Street, Payer Enrollment DepartmentMiami Gardens, FL 33169 · (786) 870-4039 · Fax (786) 870-4039

Phone(305) 628-6117

Fax(305) 363-5989

Organization SubpartYesParent: Dedicated Pennsylvania Mayfair

Authorized OfficialRaymond JimenezDirector Of Client Services · (786) 870-4039

Enumeration DateFebruary 15, 2018

Last NPPES UpdateMarch 27, 20182 updates tracked since enumeration

✔ NPI 1477053569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

Also ListedNon-Pharmacy Dispensing SiteTaxonomy 332900000X

6431 SACKETT ST, Philadelphia, PA 19149

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Other Names 1

Doing Business AsDedicated Pennsylvania Mayfair

Group Practice 2

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

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dedicated Pennsylvania Mayfair is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 58 clinicians reassign Medicare billing to Dedicated Pennsylvania Mayfair, which bills Medicare for the services they deliver. Of these, 10 practice at this address and 40 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 6

Family Practice24

Internal Medicine23

Nurse Practitioner8

Cardiovascular Disease (Cardiology)1

Hospitalist1

Podiatry1

Nearest to this location (20)

See all 58

Lisa Abdul-Haqq, CRNP

Nurse Practitioner

NPI 1982369708

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOS✔ Accepts MedicareSame address

Anabel Disla Wallace, NP

Nurse Practitioner

NPI 1487447231

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOS✔ Accepts MedicareSame address

Ellen Kim, MD

Family Practice

NPI 1912069329

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOS✔ Accepts MedicareSame address

Tien Nguyen, NP

Nurse Practitioner

NPI 1700361276

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Poonguzhali Pichaimuthu, M.D.

Internal Medicine

NPI 1659567501

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOS✔ Accepts MedicareSame address

Peter Rajacic

Internal Medicine

NPI 1023351921

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Seth Rubin, MD

Family Practice

NPI 1235102542

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Stephanie Santoro, D.O.

Internal Medicine

NPI 1609026640

6431 SACKETT ST STE 400
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Young Vu

Nurse Practitioner

NPI 1508448192

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Timi Edeki, MD

Internal Medicine

NPI 1962647644

6431 SACKETT ST
Philadelphia, PA 19149

(267) 448-4908

✔ PECOSSame address

Cynthia Gary

Nurse Practitioner

NPI 1710596481

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS✔ Accepts Medicare3.3 mi

Lisa Keiner, DO

Internal Medicine

NPI 1497865497

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS3.3 mi

Indira Martinez, MD

Family Practice

NPI 1821519927

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS✔ Accepts Medicare3.3 mi

Gillian Reid, MD

Family Practice

NPI 1366843138

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS✔ Accepts Medicare3.3 mi

Waqas Salam, DO

Internal Medicine

NPI 1609337245

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS✔ Accepts Medicare3.3 mi

Eliana Serna Martinez

Nurse Practitioner

NPI 1124764840

5675 N FRONT ST
Philadelphia, PA 19120

(215) 279-6999

✔ PECOS✔ Accepts Medicare3.3 mi

Stephen Stonehouse, M.D.

Family Practice

NPI 1285904706

5675 N FRONT ST STE 141
Philadelphia, PA 19120

(267) 428-6575

✔ PECOS✔ Accepts Medicare3.3 mi

Haresh Punjabi, MD

Family Practice

NPI 1316985906

2250 E ALLEGHENY AVE
Philadelphia, PA 19134

(215) 427-3343

✔ PECOS3.8 mi

Naiema Benson, D.O.

Internal Medicine

NPI 1730491770

2101 W LEHIGH AVE STE A
Philadelphia, PA 19132

(267) 866-7211

✔ PECOS✔ Accepts Medicare6.2 mi

Ephraim Dunn, D. O.

Family Practice

NPI 1932536232

2101 W LEHIGH AVE STE A
Philadelphia, PA 19132

(264) 866-7211

✔ PECOS✔ Accepts Medicare6.2 mi

See all 58 clinicians

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 Dedicated Pennsylvania Holding, LLC's NPI number?

The NPI number for Dedicated Pennsylvania Holding, LLC is 1477053569. It was assigned to this organization in the NPPES registry on February 15, 2018. The provider is doing business as Dedicated Pennsylvania Mayfair.

Where is Dedicated Pennsylvania Holding, LLC located?

Dedicated Pennsylvania Holding, LLC is located at 6431 Sackett St, Philadelphia, PA 19149. The listed phone number is (305) 628-6117.

What is Dedicated Pennsylvania Holding, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Dedicated Pennsylvania Holding, LLC enrolled in Medicare?

Yes. Dedicated Pennsylvania Holding, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dedicated Pennsylvania Holding, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 58 clinicians in 6 Medicare specialties reassign their Medicare billing to Dedicated Pennsylvania Holding, LLC. 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 Family Practice (24), Internal Medicine (23) and Nurse Practitioner (8). Of these, 10 practice at this address and 40 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Dedicated Pennsylvania Holding, LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 30 other insurers list Dedicated Pennsylvania Holding, LLC 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.

When was this NPI record last updated?

The NPPES record for Dedicated Pennsylvania Holding, LLC was last updated on March 27, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.