Individual provider Active NPI

Matthew Kaminski, CRNP

  • Acute Care Nurse Practitioner
  • Wynnewood, PA
National Provider Identifier
1093487993
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP024464 Issued in PA
Practice address
100 E Lancaster Ave FL 2
Wynnewood, PA 19096-3450
Phone
(484) 476-5570
NPI assigned
Sep 29, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP024464 PA Primary

Addresses

Primary practice location

100 E Lancaster Ave FL 2
Wynnewood, PA 19096-3450

Mailing address

1615 Melrose Ave
Havertown, PA 19083-1913
Phone (610) 457-9331

Other identifiers 1

IdentifierTypeStateIssuer
SP024464OtherPAACUTE CARE NURSE PRACTITIONER

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Wynnewwod Health Information Exchange (HIE)

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
I20220511002252 PA Practitioner - Nurse Practitioner 0042697195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Wynewood, PA 19096-3450
Phone (484) 476-6421

Hospital & facility affiliations

  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP024464PAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare CurrentSince Jan 26, 2021 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

100 E Lancaster Ave
Fl 2
Wynnewood, PA 19096
Phone (484) 476-5570

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 3

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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1093487993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MELROSE AVE",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190831913",
            "telephone_number": "610-457-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE FL 2",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "484-476-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMINSKI",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP024464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACUTE CARE NURSE PRACTITIONER",
            "identifier": "SP024464",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Wynnewwod",
            "affiliation": "N",
            "endpointDescription": "Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 E Lancaster Ave Fl 2",
            "city": "Wynnewood",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190963450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.