Individual provider Active NPI

Louis M Destefano, MD

  • Family Medicine Physician
  • Berwyn, PA
National Provider Identifier
1366474694
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD039970L Issued in PA
Practice address
1001 Chesterbrook Blvd
Suite 200
Berwyn, PA 19312-3805
Phone
(610) 576-7500
Fax
(610) 353-2140
NPI assigned
Jul 7, 2006
Last updated
Sep 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD039970L PA Primary

Addresses

Primary practice location

1001 Chesterbrook Blvd
Suite 200
Berwyn, PA 19312-3805

Mailing address

1001 Chesterbrook Blvd
Suite 200
Berwyn, PA 19312-3805
Phone (310) 576-7500

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
I20081111000732 PA Practitioner - Family Practice 6507925161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, shared by 15 NPIs, 493 clinicians

Practice addresses (Care Compare)

201 2ND Ave
Collegeville, PA 19426-3613
Phone (610) 489-7703

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD039970LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Apr 8, 1996 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst CurrentSince Apr 8, 1996 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Family Medicine Current Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

1001 Chesterbrook Blvd
Ste 200
Berwyn, PA 19312
Phone (610) 576-7500

23 Bishop Hollow Rd
Newtown Square, PA 19073
Phone (610) 353-9100

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 4

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 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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1366474694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CHESTERBROOK BLVD",
            "address_2": "SUITE 200",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193123805",
            "telephone_number": "310-576-7500",
            "fax_number": "610-353-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CHESTERBROOK BLVD",
            "address_2": "SUITE 200",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193123805",
            "telephone_number": "610-576-7500",
            "fax_number": "610-353-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "LOUIS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD039970L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, PA

Sources for this page

Verify at the official NPI Registry.