Individual provider Active NPI

David R Trevino, MD

  • Internal Medicine Physician
  • Paoli, PA
National Provider Identifier
1215918990
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD025295E Issued in PA
Practice address
255 W Lancaster Ave
Mob II Suite 121
Paoli, PA 19301-1763
Phone
(610) 647-8885
Fax
(610) 640-3832
NPI assigned
Nov 9, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD025295E PA Primary
Infectious Disease Physician 207RI0200X MD025295E PA

Addresses

Primary practice location

255 W Lancaster Ave
Mob II Suite 121
Paoli, PA 19301-1763

Mailing address

255 W Lancaster Ave
Mob II Suite 121
Paoli, PA 19301-1763
Phone (610) 647-8885

Other identifiers 1

IdentifierTypeStateIssuer
110225028OtherPARAILROAD MEDICARE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100609000952 PA Practitioner - Internal MedicinePractitioner - Infectious Disease 0042209561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

255 W Lancaster Ave
Mob II Suite 121
Paoli, PA 19301-1764
Phone (610) 647-8885

Hospital & facility affiliations

  • Paoli Hospital Hospital, Paoli, PA, CCN 390153
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Paoli Internal Medicine Associates PC Internal Medicine CurrentSince Nov 1, 2001 Accepting new patients
Bryn Mawr Medical Specialists Association PastSince Nov 1, 2001 Accepting new patients

Locations

255 W Lancaster Ave
Ste 121
Paoli, PA 19301
Phone (610) 308-6697

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 2

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1215918990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "address_2": "MOB II SUITE 121",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-647-8885",
            "fax_number": "610-640-3832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "address_2": "MOB II SUITE 121",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-647-8885",
            "fax_number": "610-640-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREVINO",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD025295E",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "PA",
            "license": "MD025295E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110225028",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paoli, PA

Sources for this page

Verify at the official NPI Registry.