Individual provider Active NPI

Nicole Lynn Renaldi, D.O.

  • Anesthesiology Physician
  • Philadelphia, PA
National Provider Identifier
1003135955
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
OS016843 Issued in PA
Practice address
111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone
(215) 955-6161
Fax
(215) 923-5507
NPI assigned
May 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OS016843 PA Primary

Addresses

Primary practice location

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824

Mailing address

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone (215) 955-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180326000047 NJ Practitioner - Anesthesiology 9830322726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Rowan University School of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Jersey Healthcare Specialists PCGroup PAC ID 2668385253, 570 clinicians

Practice addresses (Care Compare)

1 Capital Way
Pennington, NJ 08534-2520
Phone (800) 637-2374

750 Brunswick Ave
Trenton, NJ 08638-4143
Phone (609) 394-6000

901 W Main St
Freehold, NJ 07728-2537
Phone (732) 431-2000

Hospital & facility affiliations

  • Capital Health Medical Center - Hopewell Hospital, Pennington, NJ, CCN 310044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS016843PAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Healthcare Specialists PC Anesthesiology CurrentSince Apr 1, 2018 Accepting new patients

Locations

901 W Main St
Freehold, NJ 07728
Phone (732) 294-2666

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436400000000",
    "number": "1003135955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6161",
            "fax_number": "215-923-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6161",
            "fax_number": "215-923-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENALDI",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-18",
        "last_updated": "2015-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "OS016843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.