Active NPI
Diane M. Travlos, APN
- Nurse Practitioner
- Philadelphia, PA
National Provider Identifier
1104901289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- VP003505J
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0021679 | Medicaid | NJ | |
| 4039068 | Medicaid | MD |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LM-0000160 | DE | MD | Nurse Practitioner |
| VP003505J | PA | MD | Neonatal Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prospect Health Access Network, Inc. | Current | Accepting new patients | |
| Prospect Health Access Network, Inc. | Current | Accepting new patients | |
| Prospect Health Access Network, Inc. | Current | 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
- 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.
-
- Emergency Medicine Physician
- Chester, PA
- NPI 1568819084
-
- Diagnostic Radiology Physician
- Chester, PA
- NPI 1154776797
-
- Surgery Physician
- Chester, PA
- NPI 1922455443
-
- Pediatrics Physician
- Philadelphia, PA
- NPI 1255363578
-
- Children's Hospital
- Wilmington, DE
- NPI 1467505073
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.