NPIMap

Individual provider Active NPI

Diane Wolstenholme, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1417592908
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP021119 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5189
Phone
(215) 707-5030
Fax
(215) 707-3494
NPI assigned
Nov 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP021119 PA
Nurse Practitioner 363L00000X SP021119 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5189

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-5030

Other names 1

  • Diane Wolstenholme Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200303001962 PA Practitioner - Nurse Practitioner 1951738988 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line Emergency Med Associates LLCGroup PAC ID 9234034729, 51 clinicians
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians
On Demand Urgent Care Group PCGroup PAC ID 5991029712, 95 clinicians

Practice addresses (Care Compare)

1068 W Baltimore Pike
Media, PA 19063-5104
Phone (484) 337-3583

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

6060 Ridge Ave
Suite 100
Philadelphia, PA 19128-1659
Phone (215) 999-6060

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

Merit-based Incentive Payment System (MIPS)

Final score
86.37 of 100Reported as group
Quality
70.23
Promoting interoperability
100
Improvement activities
40
Cost
77.22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
On Demand Urgent Care Group PC CurrentSince Sep 3, 2023 Accepting new patients
Main Line Emergency Med Associates LLC CurrentSince Jun 2, 2025 Accepting new patients
Spuc, LLC CurrentSince Sep 1, 2021 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Feb 11, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Feb 11, 2020 Accepting new patients
Pennsylvania Urgent Care Centers, PLLC CurrentSince Oct 1, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
On Demand Urgent Care Group PC Past Accepting new patients

Locations

56 W Main St
Ste 305
Christiana, DE 19702

780 N Krocks Rd
Ste 101B
Allentown, PA 18106
Phone (610) 365-3354

5024 Pennell Rd
Aston, PA 19014
Phone (484) 456-1257

150 E Pennsylvania Ave
Ste 140
Downingtown, PA 19335
Phone (610) 518-1060

1068 W Baltimore Pike
Media, PA 19063
Phone (610) 566-9400

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3356 Aramingo Ave
Philadelphia, PA 19134
Phone (215) 739-6600

1444 W Passyunk Ave
Philadelphia, PA 19145
Phone (215) 389-4444

8835 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8227

6060 Ridge Ave
Ste 100
Philadelphia, PA 19128
Phone (215) 483-6600

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

Interoperability endpoints

  • Direct secure messaging: diane.wolstenholme.1@14965.direct.athenahealth.com

Organizations & group practices 9

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.

Hospital & facility affiliations 8

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": "1573171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1417592908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-5030",
            "fax_number": "215-707-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405189",
            "telephone_number": "215-707-5030",
            "fax_number": "215-707-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLSTENHOLME",
        "first_name": "DIANE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-08",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP021119",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP021119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "WOLSTENHOLME",
            "credential": "CRNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.