Individual provider Active NPI

Sophia Victoria Wasserwald, CRNP

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1376176370
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP021057 Issued in PA
Practice address
800 Walnut St FL 9
Philadelphia, PA 19107-5176
Phone
(215) 316-5151
NPI assigned
Feb 18, 2020
Last updated
Jun 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP021057 PA Primary

Addresses

Primary practice location

800 Walnut St FL 9
Philadelphia, PA 19107-5176

Mailing address

800 Walnut St FL 9
Philadelphia, PA 19107-5176
Phone (215) 829-5027

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
I20200311000281 PA Practitioner - Nurse Practitioner 9537597208 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
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

800 Walnut St Wash SQ
9TH Harron Lung Ctr Wash
Philadelphia, PA 19107-5176
Phone (215) 829-5027

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Apr 6, 2020 Accepting new patients
University of Penn - Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Apr 6, 2020 Accepting new patients

Locations

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

800 Walnut St
Philadelphia, PA 19107
Phone (215) 454-3528

800 Walnut St
Fl 9
Philadelphia, PA 19107
Phone (215) 829-5027

Organizations & group practices 3

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 5

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": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1376176370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WALNUT ST FL 9",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075176",
            "telephone_number": "215-829-5027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WALNUT ST FL 9",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075176",
            "telephone_number": "215-316-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERWALD",
        "first_name": "SOPHIA",
        "middle_name": "VICTORIA",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP021057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.