Individual provider Active NPI

Diane M. Travlos, APN

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1104901289
Registry record updated May 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
VP003505J Issued in PA
Practice address
Thomas Jefferson University Hospital
111 S. 11TH Street
Philadelphia, PA 19107
Phone
(215) 955-6000
Fax
(215) 923-9519
NPI assigned
Oct 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LM-0000160 DE
Neonatal Nurse Practitioner 363LN0000X VP003505J PA
Critical Care Neonatal Nurse Practitioner 363LN0005X VP003505J PA
Nurse Practitioner 363L00000X VP003505J PA Primary

Addresses

Primary practice location

Thomas Jefferson University Hospital
111 S. 11TH Street
Philadelphia, PA 19107

Mailing address

PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-4000

Other identifiers 2

IdentifierTypeStateIssuer
0021679MedicaidNJ
4039068MedicaidMD

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
I20040322000491 PA Practitioner - Nurse Practitioner 0547151516 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LM-0000160DEMDNurse Practitioner
VP003505JPAMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. Current Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Oct 23, 2016 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Oct 23, 2016 Accepting new patients
The Nemours Foundation Past Accepting new patients
SCHC Pediatric Associates, LLC Past Accepting new patients

Locations

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

1 Medical Center Blvd
Fl 3
Chester, PA 19013
Phone (610) 447-6666

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Interoperability endpoints

  • Direct secure messaging: dtravlos65558@direct.nemours.org

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1104901289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-4000",
            "fax_number": "302-651-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THOMAS JEFFERSON UNIVERSITY HOSPITAL",
            "address_2": "111 S. 11TH STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-955-6000",
            "fax_number": "215-923-9519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVLOS",
        "first_name": "DIANE",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LM-0000160",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "PA",
            "license": "VP003505J",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "PA",
            "license": "VP003505J",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "VP003505J",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0021679",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4039068",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.