Individual provider Active NPI

Marilyn Irene Spagnol, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1174905657
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00371600 Issued in NJ
Practice address
5501 Old York Rd
Philadelphia, PA 19141-3018
Phone
(215) 456-6560
NPI assigned
Jun 22, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA057625 PA
Physician Assistant 363A00000X 25MP00371600 NJ Primary

Addresses

Primary practice location

5501 Old York Rd
Philadelphia, PA 19141-3018

Mailing address

1616 County Line Rd
Chalfont, PA 18914-1201
Phone (215) 589-0262

Other practice location 1

175 Madison Ave Fl 2
Mount Holly, NJ 08060-2038
Phone (609) 914-6000

Other practice location 2

90 Brick Rd Fl 3
Marlton, NJ 08053-2177
Phone (856) 355-6000

Other practice location 3

100 Bowman Dr Lowr Level1
Voorhees, NJ 08043-9612
Phone (856) 247-3000

Other practice location 4

218 Sunset Rd Fl 5
Willingboro, NJ 08046-1110
Phone (609) 835-3056

Other practice location 5

1600 Haddon Ave Fl 6
Camden, NJ 08103-3101
Phone (856) 757-3500

Other names 1

  • Marilyn Beatty Former name

Electronic endpoints 5

TypeEndpointUseAffiliation
Direct Messaging Address mbeatty111758@directvirtua.org
Direct Messaging Address mbeatty111758@directvirtua.org
Direct Messaging Address mbeatty111758@directvirtua.org
Direct Messaging Address mbeatty111758@directvirtua.org
Direct Messaging Address mbeatty111758@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150722005779 PA Practitioner - Physician Assistant 6406169283 Reassigns benefits to 1 organization
I20151106001831 NJ Practitioner - Physician Assistant 6406169283 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Haddon Emergency Physicians LLCGroup PAC ID 4082514229, 21 clinicians

Practice addresses (Care Compare)

1600 Haddon Ave
Camden, NJ 08103-3101
Phone (954) 939-5000

Hospital & facility affiliations

  • Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00371600NJMDPhysician Assistant
MA057625PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc CurrentSince Jul 7, 2015 Accepting new patients
Virtua Medical Group, PA CurrentSince Dec 1, 2021 Accepting new patients
Virtua Medical Group, PA Physician Assistant CurrentSince Dec 1, 2021 Accepting new patients
Einstein Practice Plan Inc CurrentSince Jul 7, 2015 Accepting new patients
Einstein Practice Plan Inc Past Accepting new patients
Virtua Medical Group, PA Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1600 Haddon Ave
Fl 6
Camden, NJ 08103
Phone (856) 247-2160

90 Brick Rd
Fl 3
Marlton, NJ 08053
Phone (856) 247-2160

175 Madison Ave
Fl 2
Mount Holly, NJ 08060
Phone (609) 914-6198

100 Bowman Dr
Lowr
Voorhees, NJ 08043
Phone (856) 247-3000

218 Sunset Rd
Fl 5
Willingboro, NJ 08046
Phone (609) 444-0359

5501 York Rd
Philadelphia, PA 19141
Phone (215) 456-7405

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

5501 York Rd
Ste 202
Philadelphia, PA 19141
Phone (215) 254-2630

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1174905657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 COUNTY LINE RD",
            "city": "CHALFONT",
            "state": "PA",
            "postal_code": "189141201",
            "telephone_number": "215-589-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "215-456-6560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Madison Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Mount Holly",
            "state": "NJ",
            "postal_code": "080602038",
            "country_code": "US",
            "telephone_number": "609-914-6000",
            "fax_number": "609-914-6182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "90 Brick Rd Fl 3",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "080532177",
            "country_code": "US",
            "telephone_number": "856-355-6000",
            "fax_number": "856-355-6731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Bowman Dr Lowr Level1",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080439612",
            "country_code": "US",
            "telephone_number": "856-247-3000",
            "fax_number": "856-247-2597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "218 Sunset Rd Fl 5",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-835-3056",
            "fax_number": "609-835-5741",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 Haddon Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081033101",
            "country_code": "US",
            "telephone_number": "856-757-3500",
            "fax_number": "856-365-4088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPAGNOL",
        "first_name": "MARILYN",
        "middle_name": "IRENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA057625",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00371600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbeatty111758@directvirtua.org",
            "affiliation": "N",
            "address_1": "1600 Haddon Ave Fl 6",
            "city": "Camden",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081033101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbeatty111758@directvirtua.org",
            "affiliation": "N",
            "address_1": "175 Madison Ave Fl 2",
            "city": "Mount Holly",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080602038",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbeatty111758@directvirtua.org",
            "affiliation": "N",
            "address_1": "100 Bowman Dr Lowr Level1",
            "city": "Voorhees",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080439612",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbeatty111758@directvirtua.org",
            "affiliation": "N",
            "address_1": "90 Brick Rd Fl 3",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080532177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbeatty111758@directvirtua.org",
            "affiliation": "N",
            "address_1": "218 Sunset Rd Fl 5",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "BEATTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.