Louis M Destefano, MD
Individual provider Active NPI Family Medicine Physician · Berwyn, PA
NPI 1366474694 · NPPES record last updated Sep 12, 2022
Key facts
- NPI
- 1366474694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD039970L (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Novacare Outpatient Rehabilitation East, Inc.
Practice addresses (Care Compare)
201 2ND Ave
Collegeville, PA 19426-3613
Phone (610) 489-7703
Hospital & facility affiliations
- Hospital of Univ of Pennsylvania
- Chester County Hospital
- Bryn Mawr Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081111000732 | PA | Practitioner - Family Practice | 6507925161 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD039970L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Care Associates of the University of Pennsylvania Health Syst | Current |
Accepting new patients | |
| Clinical Care Associates of the University of Pennsylvania Health | Current |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD039970L | PA | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0116015060001 | Medicaid | PA |
Other providers in Berwyn, PA
- Madhura Damle
- David M. Taylor D.M.D and Eileen Leone-Taylor D.M.D Partners
- Nicole M. Davis
- Amy Deahl-Greenlaw
- Donald Desantis
- Devereux Foundation
- Devereux Foundation
- Devereux Foundation
- Devereux Foundation
- Devereux Foundation
All providers in Berwyn, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.