Individual provider Active NPI

Jessica Weatherwax, CRNP

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1225617731
Registry record updated Apr 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP023562 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 316-5151
NPI assigned
Apr 3, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP023562 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

309 Locust Ave
Haddon Township, NJ 08108-2420

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
I20220615000209 PA Practitioner - Nurse Practitioner 9335528728 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 615-4949

3400 Spruce St 210 White BLDG
Renal Electrolyte Hup
Philadelphia, PA 19104-4228
Phone (215) 662-2638

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP023562PAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince May 1, 2022 Accepting new patients
University of Penn - Medical Group CurrentSince Feb 15, 2026 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2022 Accepting new patients
University of Penn-Medical Group Current Accepting new patients

Locations

PO B0x 824320
Philadelphia, PA 19182

3400 Spruce St
Fl 4
Philadelphia, PA 19104
Phone (215) 662-2050

Organizations & group practices 5

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 4

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": "1617408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617408000000",
    "number": "1225617731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 LOCUST AVE",
            "city": "HADDON TOWNSHIP",
            "state": "NJ",
            "postal_code": "081082420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-316-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERWAX",
        "first_name": "JESSICA",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-03",
        "last_updated": "2021-04-03",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP023562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.