Individual provider Active NPI

Cassandra Elizzabeth Haddad, CRNP

  • Family Nurse Practitioner
  • Mechanicsburg, PA
National Provider Identifier
1073801619
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP011486 Issued in PA
Practice address
310 Lambs Gap Rd
Mechanicsburg, PA 17050-2522
Phone
(717) 795-9566
Fax
(717) 795-9567
NPI assigned
Jul 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP011486 PA Primary

Addresses

Primary practice location

310 Lambs Gap Rd
Mechanicsburg, PA 17050-2522

Mailing address

310 Lambs Gap Rd
Mechanicsburg, PA 17050-2522
Phone (717) 795-9566

Other practice location 1

107 W End Dr
Manheim, PA 17545-9320
Phone (717) 879-9899

Other identifiers 1

IdentifierTypeStateIssuer
102667434MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120213000280 PA Practitioner - Nurse Practitioner 2365609765 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Jun 16, 2012 Accepting new patients
Alder Health Services, Inc. Family CurrentSince Dec 31, 2011 Accepting new patients
Lancaster General Medical Group CurrentSince Jun 16, 2012 Accepting new patients
Lancaster General Medical Group Current Accepting new patients
Turnpaugh Health and Wellness Center PC CurrentSince Dec 10, 2019 Accepting new patients

Locations

100 N Cameron St
Ste 301E
Harrisburg, PA 17101
Phone (717) 233-7190

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

562 W 2nd Ave
Lititz, PA 17543
Phone (717) 626-2167

310 N Salem Church Rd
Mechanicsburg, PA 17050
Phone (717) 591-1425

Interoperability endpoints

  • Direct secure messaging: cweber@directaddress.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1073801619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 LAMBS GAP RD",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170502522",
            "telephone_number": "717-795-9566",
            "fax_number": "717-795-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 LAMBS GAP RD",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170502522",
            "telephone_number": "717-795-9566",
            "fax_number": "717-795-9567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 W End Dr",
            "address_purpose": "LOCATION",
            "city": "Manheim",
            "state": "PA",
            "postal_code": "175459320",
            "country_code": "US",
            "telephone_number": "717-879-9899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "CASSANDRA",
        "middle_name": "ELIZZABETH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-18",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP011486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102667434",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mechanicsburg, PA

Sources for this page

Verify at the official NPI Registry.