Individual provider Active NPI

Tetiana Lyubovich

  • Nurse Practitioner
  • Phoenixville, PA
National Provider Identifier
1104416478
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP022886 Issued in PA
Practice address
824 Main St Ste 306
Phoenixville, PA 19460-4478
Phone
(610) 983-1941
NPI assigned
Jan 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 688621 PA
Nurse Practitioner 363L00000X SP022886 PA Primary

Addresses

Primary practice location

824 Main St Ste 306
Phoenixville, PA 19460-4478

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-5455

Other practice location 1

851 Red Lion Rd Apt A5
Philadelphia, PA 19115-1427
Phone (126) 746-9259

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
I20240522001035 PA Practitioner - Nurse Practitioner 9234571217 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reading HospitalGroup PAC ID 7618886490, 179 clinicians
Phoenixville Clinic Company LLCGroup PAC ID 5799796850, 135 clinicians

Practice addresses (Care Compare)

301 S 7TH Ave
Suite 2020
West Reading, PA 19611-1495
Phone (610) 375-6565

824 Main St
Suite 306
Phoenixville, PA 19460-4478
Phone (610) 983-1530

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
688621PAMDRegistered Nurse
SP022886PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reading Hospital CurrentSince Nov 1, 2024 Accepting new patients
Phoenixville Clinic Company LLC Nurse Practitioner Current Accepting new patients
Reading Hospital Current Accepting new patients
Reading Hospital CurrentSince Nov 1, 2024 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince May 17, 2024 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince May 17, 2024 Accepting new patients
Reading Professional Services Past Accepting new patients

Locations

31 Industrial Dr
Ste 150
Hamburg, PA 19526
Phone (610) 376-8671

824 Main St
Ste 302
Phoenixville, PA 19460
Phone (610) 917-9551

824 Main St
Ste 306
Phoenixville, PA 19460
Phone (610) 983-1941

140 Nutt Rd
Phoenixville, PA 19460
Phone (610) 983-1000

296 W Ridge Pike
Royersford, PA 19468
Phone (484) 706-9465

206 S 6th Ave
West Reading, PA 19611
Phone (484) 628-5437

301 S 7th Ave
Ste 2020
West Reading, PA 19611

1320 Broadcasting Rd
Ste 107
Wyomissing, PA 19610
Phone (484) 628-0319

1320 Broadcasting Rd
Ste 100
Wyomissing, PA 19610

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1606/brand/1/csg/101/fhir/r4

Organizations & group practices 7

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

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": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1104416478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 MAIN ST STE 306",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194604478",
            "telephone_number": "610-983-1941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "851 Red Lion Rd Apt A5",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191151427",
            "country_code": "US",
            "telephone_number": "126-746-9259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYUBOVICH",
        "first_name": "TETIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "688621",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP022886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenixville, PA

Sources for this page

Verify at the official NPI Registry.