NPIMap

Individual provider Active NPI

Kirsten Debra Eisenhower, CRNP

  • Family Nurse Practitioner
  • Fleetwood, PA
National Provider Identifier
1174092191
Registry record updated Nov 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP019507 Issued in PA
Practice address
805 N Richmond St
Fleetwood, PA 19522-1058
Phone
(610) 944-0464
NPI assigned
Nov 20, 2018
Last updated
Nov 20, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP019507 PA Primary

Addresses

Primary practice location

805 N Richmond St
Fleetwood, PA 19522-1058

Mailing address

805 N Richmond St
Fleetwood, PA 19522-1058
Phone (610) 944-0464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20190110000307 PA Practitioner - Nurse Practitioner 4284970344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
St Joseph Medical GroupGroup PAC ID 3779688650, 190 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

805 N Richmond St
Fleetwood, PA 19522-1058
Phone (610) 944-0464

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.31 of 100Reported as group
Quality
55.01
Promoting interoperability
99
Improvement activities
40
Cost
76.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP019507PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Medical Group Multi-Specialty CurrentSince Nov 19, 2018 Accepting new patients
St. Joseph Medical Group Multi-Specialty CurrentSince Nov 19, 2018 Accepting new patients
Integrated Medical Group, P.C. Multi-Specialty Past Accepting new patients

Locations

805 N Richmond St
Fleetwood, PA 19522
Phone (610) 944-0464

805 N Richmond St
Ste 101
Fleetwood, PA 19522
Phone (610) 944-0464

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

Organizations & group practices 3

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1174092191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N RICHMOND ST",
            "city": "FLEETWOOD",
            "state": "PA",
            "postal_code": "195221058",
            "telephone_number": "610-944-0464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 N RICHMOND ST",
            "city": "FLEETWOOD",
            "state": "PA",
            "postal_code": "195221058",
            "telephone_number": "610-944-0464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENHOWER",
        "first_name": "KIRSTEN",
        "middle_name": "DEBRA",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-20",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP019507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleetwood, PA

Sources for this page

Verify at the official NPI Registry.