Individual provider Active NPI

Caroline Clark Brugger, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1184934960
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN626943 Issued in PA
Practice address
1015 Chestnut St
Suite 1020
Philadelphia, PA 19107-4316
Phone
(215) 955-7785
Fax
(215) 955-9362
NPI assigned
Oct 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP011551 PA
Nurse Practitioner 363L00000X RN626943 PA Primary
Nurse Practitioner 363L00000X 014280 PA

Addresses

Primary practice location

1015 Chestnut St
Suite 1020
Philadelphia, PA 19107-4316

Mailing address

1015 Chestnut St
Suite 1020
Philadelphia, PA 19107-4316
Phone (215) 955-7785

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
I20121031000402 PA Practitioner - Nurse Practitioner 9032306931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Florida College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1015 Chestnut St
Suite 1020
Philadelphia, PA 19107-4310
Phone (215) 955-4730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP011551PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Sep 10, 2012 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

1015 Chestnut St
Ste 1020
Philadelphia, PA 19107
Phone (215) 955-4730

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1101 Chestnut St
#11
Philadelphia, PA 19107

Organizations & group practices 2

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": "1287014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374105600000",
    "number": "1184934960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST",
            "address_2": "SUITE 1020",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074316",
            "telephone_number": "215-955-7785",
            "fax_number": "215-955-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST",
            "address_2": "SUITE 1020",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074316",
            "telephone_number": "215-955-7785",
            "fax_number": "215-955-9362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUGGER",
        "first_name": "CAROLINE",
        "middle_name": "CLARK",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-14",
        "last_updated": "2013-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP011551",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "RN626943",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "014280",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.