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DR. MICHAEL P DUNCAN MD
NPI 1588993596
Family Medicine - Sports Medicine in Philadelphia, PA

Active since December 22, 2009PECOS EnrolledAccepts Medicare Assignment
92.09/100
CMS Quality Rating
925 CHESTNUT ST, 5TH FLOOR, PHILADELPHIA, PA 19107(267) 339-3500(267) 339-3761 Get Directions Write a Review

NPPES record last updated: November 10, 2015. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Michael P Duncan Md NPPES

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

DR. MICHAEL P DUNCAN MD (NPI 1588993596) is an individual sports medicine provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (MD439452) and active in the NPI registry since December 2009. He is enrolled in Medicare PECOS, is affiliated with Hospital Of Univ Of Pennsylvania, and is a graduate of Georgetown University School Of Medicine (2007).

NPPES Registry Identity

NPI1588993596
Entity TypeIndividualMale
Primary Taxonomy207QS0010X
Provider Legal NameDR. MICHAEL P DUNCANCredential: MD
Location Address925 CHESTNUT ST, 5TH FLOORPhiladelphia, PA 19107-4216
Mailing Address833 Chestnut St, Suite 1402Philadelphia, PA 19107-4414 · (800) 321-9999 · Fax (267) 339-3761
Phone(267) 339-3500
Fax(267) 339-3761
Sole ProprietorNo
Medical School CMSGeorgetown University School Of MedicineGraduated 2007
Enumeration DateDecember 22, 2009
Last NPPES UpdateNovember 10, 2015
✔ NPI 1588993596 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
License✔ Licensed in PA · MD439452
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
Also ListedFamily MedicineTaxonomy 207Q00000X · License MT190706 (PA)
925 CHESTNUT ST, Philadelphia, PA 19107
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Accepted Insurance

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

Dr. Michael P Duncan 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 ID2860663499
PECOS Enrollment IDI20110912000536
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 Reassignment

Medicare enrollment records show Michael Duncan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Reconstructive Orthopaedic Associates II LLC
0.1 mi
Orthopaedic Surgery
833 CHESTNUT ST STE 1220
Philadelphia, PA 19107
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 361 clinicians in this Medicare group
NPI 1861433278 (800) 321-9999

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 11

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.

Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg J7329
Trivisc is a treatment involving injections of a substance called hyaluronan into your joint, typically the knee. This substance is similar to a natural fluid in your joints that helps cushion and lubricate them. Trivisc can help reduce pain and improve joint movement.
4,950 services47 patients
Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301
Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.
1,280 services167 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.
318 services138 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.
125 services104 patients
Aspiration and/or injection of fluid large joint using ultrasound guidance 20611
This procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.
124 services99 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.
99 services99 patients

Hospital Affiliations CMS Care Compare 3

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

Hospital Of Univ Of Pennsylvania

Acute Care Hospitals · Philadelphia, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390111
Location34th & Spruce StsPhiladelphia, PA 19104 · Philadelphia County
Emergency services Birthing friendly

Bryn Mawr Hospital

Acute Care Hospitals · Bryn Mawr, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390139
Location130 South Bryn Mawr AveBryn Mawr, PA 19010 · Montgomery County
Emergency services Birthing friendly

Main Line Hospital Lankenau

Acute Care Hospitals · Wynnewood, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390195
Location100 Lancaster AveWynnewood, PA 19096 · Montgomery County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19107 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
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.09/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality86.6
Promoting Interoperability99
Improvement Activities40
Cost87.88

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.

DR. MATTHEW DECARO M.D.
Internal Medicine (Cardiovascular Disease)
925 CHESTNUT ST, MEZZANINE
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-5050
DR. MANISH SHARMA MD
Internal Medicine (Medical Oncology)
925 CHESTNUT ST, SUITE 320A
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-8874
MS. ELEANOR LYNN VANDERKLOK CRNP
Nurse Practitioner (Adult Health)
925 CHESTNUT ST, SUITE 320A
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-8874
LEANNE MCKEOWN PA-C
Physician Assistant
925 CHESTNUT ST, FIFTH FLOOR
PHILADELPHIA, PA 19107
Philadelphia County (267) 339-3500
WILLIAM KEVIN KELLY DO
Internal Medicine (Medical Oncology)
925 CHESTNUT ST, SUITE 320A
PHILADELPHIA, PA 19107
Philadelphia County (215) 995-8874
DR. MARC R. ROSEN M.D.
Otolaryngology
925 CHESTNUT ST, 6TH FLOOR
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6760
ANDREW B NEWBERG MD
Nuclear Medicine
925 CHESTNUT ST, SUITE 120
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-3422
DR. HOWARD H. WEITZ M.D.
Internal Medicine (Cardiovascular Disease)
925 CHESTNUT ST, MEZZANINE FLOOR
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-5050

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 Michael Duncan's NPI number?

The NPI number for Michael Duncan is 1588993596. It was assigned to this individual provider in the NPPES registry on December 22, 2009.

Where is Michael Duncan located?

Michael Duncan practices at 925 Chestnut St 5th Floor, Philadelphia, PA 19107. The listed phone number is (267) 339-3500.

What is Michael Duncan's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Is Michael Duncan enrolled in Medicare?

Yes. Michael Duncan 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 organization bills Medicare for Michael Duncan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michael Duncan reassigns Medicare benefits to Reconstructive Orthopaedic Associates II LLC (Philadelphia, PA). The 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 Michael Duncan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Michael Duncan accept?

Health plans from Ambetter Health and Ambetter from Buckeye Health Plan list Michael Duncan 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 Michael Duncan affiliated with any hospitals?

According to CMS data, Michael Duncan is affiliated with Hospital Of Univ Of Pennsylvania, Bryn Mawr Hospital and Main Line Hospital Lankenau.

When was this NPI record last updated?

The NPPES record for Michael Duncan was last updated on November 10, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.