Individual provider Active NPI

Abigail M O'Connell

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1346877198
Registry record updated Mar 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP021643 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 955-8229
NPI assigned
Mar 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP021643 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

200 4TH Ave
Glendora, NJ 08029-1420
Phone (267) 303-9401

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
I20201125002597 PA Practitioner - Nurse Practitioner 1456762376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
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)

211 S 9TH St
Suite 402
Philadelphia, PA 19107-6810
Phone (215) 955-0020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP021643PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Sep 14, 2020 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

3 Crescent Dr
#4
Philadelphia, PA 19112

211 S 9th St
Ste 402
Philadelphia, PA 19107
Phone (215) 955-0019

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

1300 Wolf St
Fl 1
Philadelphia, PA 19148
Phone (215) 551-0360

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

925 Chestnut St
Fl 4
Philadelphia, PA 19107
Phone (215) 955-5772

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1346877198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 4TH AVE",
            "city": "GLENDORA",
            "state": "NJ",
            "postal_code": "080291420",
            "telephone_number": "267-303-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNELL",
        "first_name": "ABIGAIL",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP021643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.