Active NPI
Karin Jonczak, C.R.N.P.
- Acute Care Nurse Practitioner
- Willow Grove, PA
National Provider Identifier
1174859235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- SP010525
- Practice address
- 2510 Maryland Rd
Suite 185
Willow Grove, PA 19090-1109 - Phone
- (215) 657-5886
- Fax
- (215) 657-9996
- NPI assigned
- Oct 26, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN604316 | PA | |
| Acute Care Nurse Practitioner | 363LA2100X | SP010525 | PA | Primary |
Addresses
Primary practice location
2510 Maryland Rd
Suite 185
Willow Grove, PA 19090-1109
Mailing address
2510 Maryland Rd
Suite 185
Willow Grove, PA 19090-1109
Phone (215) 657-5886
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1024191690001 | Medicaid | PA | |
| 1174859235 | Other | PA | HEALTHPARTNERS - PA |
| 2138224 | Other | PA | HIGHMARK BCBS |
Other names 1
- Karin Kellerman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318896000000",
"number": "1174859235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2510 MARYLAND RD",
"address_2": "SUITE 185",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901109",
"telephone_number": "215-657-5886",
"fax_number": "215-657-9996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2510 MARYLAND RD",
"address_2": "SUITE 185",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901109",
"telephone_number": "215-657-5886",
"fax_number": "215-657-9996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONCZAK",
"first_name": "KARIN",
"credential": "C.R.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-26",
"last_updated": "2011-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "RN604316",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "PA",
"license": "SP010525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1024191690001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS - PA",
"identifier": "1174859235",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BCBS",
"identifier": "2138224",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KARIN",
"last_name": "KELLERMAN",
"credential": "C.R.N.P.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Willow Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.