Individual provider Active NPI

Nikki A Devito, PA-C

  • Physician Assistant
  • Elizabethtown, PA
National Provider Identifier
1255846812
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA059412 Issued in PA
Practice address
1 Continental Dr
Elizabethtown, PA 17022-2231
Phone
(717) 361-0666
Fax
(717) 361-0202
NPI assigned
Dec 5, 2017
Last updated
Jun 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA059412 PA Primary

Addresses

Primary practice location

1 Continental Dr
Elizabethtown, PA 17022-2231

Mailing address

2500 English Creek Ave Ste 1202
Egg Harbor Township, NJ 08234-5597
Phone (609) 677-6000

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
I20180126000971 PA Practitioner - Physician Assistant 7810256500 Reassigns benefits to 1 organization
I20230523001391 NJ Practitioner - Physician Assistant 7810256500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

2500 English Creek Ave
Egg Harbor Township, NJ 08234-5549

459 Route 9 S
Little Egg Harbor TWP, NJ 08087-2225
Phone (609) 340-7815

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA059412PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince May 9, 2023 Accepting new patients
University of Penn - Medical Group CurrentSince Jul 20, 2020 Accepting new patients
University of Penn-Medical Group CurrentSince Jul 20, 2020 Accepting new patients
Atlanticare Physician Group Past Accepting new patients

Locations

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1255846812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE STE 1202",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345597",
            "telephone_number": "609-677-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CONTINENTAL DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222231",
            "telephone_number": "717-361-0666",
            "fax_number": "717-361-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVITO",
        "first_name": "NIKKI",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-05",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, PA

Sources for this page

Verify at the official NPI Registry.