Individual provider Active NPI

Michael Joseph Wenclawiak, PA-C

  • Physician Assistant
  • Bryn Mawr, PA
National Provider Identifier
1376114991
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA065496 Issued in PA
Practice address
825 Old Lancaster Rd Ste 100&200
Bryn Mawr, PA 19010-3231
Phone
(800) 321-9999
NPI assigned
Jul 6, 2021
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA065496 PA Primary
Physician Assistant 363A00000X 10486 GA

Addresses

Primary practice location

825 Old Lancaster Rd Ste 100&200
Bryn Mawr, PA 19010-3231

Mailing address

833 Chestnut St Ste 520
Philadelphia, PA 19107-4430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, PA2 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
I20210726001750 GA Practitioner - Physician Assistant 0648673814 Reassigns benefits to 1 organization
I20240504000346 PA Practitioner - Physician Assistant 0648673814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1200 Manor Dr
Chalfont, PA 18914-2282
Phone (215) 830-8700

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

825 Old Lancaster Rd
Bryn Mawr, PA 19010-3231
Phone (800) 321-9999

925 Chestnut St
FL 5
Philadelphia, PA 19107-4206
Phone (267) 339-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.23 of 100Reported as group
Quality
65.74
Promoting interoperability
100
Improvement activities
40
Cost
78.37

Merit-based Incentive Payment System (MIPS)

Final score
88.32 of 100Reported as group
Quality
79.04
Promoting interoperability
99
Improvement activities
40
Cost
82.85

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Harbin Clinic, LLC Current Accepting new patients
Reconstructive Orthopaedic Associates II LLC CurrentSince May 20, 2024 Accepting new patients
Harbin Clinic, LLC CurrentSince Jul 26, 2021 Accepting new patients

Locations

1825 Martha Berry Blvd NW
Rome, GA 30165
Phone (706) 238-8073

221 Technology Pkwy NW
Rome, GA 30165
Phone (762) 235-1000

825 Old Lancaster Rd
Ste 100200
Bryn Mawr, PA 19010

833 Chestnut St
Ste 520
Philadelphia, PA 19107
Phone (267) 592-6191

925 Chestnut St
Fl 5
Philadelphia, PA 19107
Phone (267) 339-3738

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": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1376114991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 520",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 OLD LANCASTER RD STE 100&200",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103231",
            "telephone_number": "800-321-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENCLAWIAK",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-06",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA065496",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

Verify at the official NPI Registry.