NPIMap

Individual provider Active NPI

Stephanie Lynn Nitzschke, MD

  • Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1104092287
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD445754 Issued in PA
Practice address
3400 Spruce Street
2 Dulles
Philadelphia, PA 19104
Phone
(215) 662-7320
NPI assigned
May 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X MD445754 PA
Surgery Physician 208600000X MD445754 PA Primary

Addresses

Primary practice location

3400 Spruce Street
2 Dulles
Philadelphia, PA 19104

Mailing address

3400 Spruce Street
5 Maloney
Philadelphia, PA 19104
Phone (215) 662-7323

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141210001008 MA Practitioner - General Surgery 7719128685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brigham and Womens Physicians Organization IncGroup PAC ID 3870405988, 2,931 clinicians

Practice addresses (Care Compare)

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

  • Mass General Brigham Home Care, Inc Home health agency, Newton, MA, CCN 227207
  • Hopehealth Hospice & Palliative Care Hospice, Attleboro, MA, CCN 221512
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • South Shore Hospital Hospital, South Weymouth, MA, CCN 220100
  • Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119
  • Dana-Farber Cancer Institute Hospital, Boston, MA, CCN 220162

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD445754PAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women'S Hospital Current Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients
University of Penn-PA Trauma Surgery Past Accepting new patients
Brigham & Womens Hospital, Inc. Past Accepting new patients

Locations

75 Francis St
Boston, MA 02115

75 Francis St
#360U2
Boston, MA 02115

Interoperability endpoints

  • Direct secure messaging: nitzschke.stephanie.bwh@direct.partners.masshiway.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.

Hospital & facility affiliations 7

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": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1104092287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "5 MALONEY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-7323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "2 DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NITZSCHKE",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-07",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "PA",
            "license": "MD445754",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD445754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.