ABA Fahnbulleh, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP014415 Issued in PA

Practice address

1001 S George St FL 2
York, PA 17403

Phone

(717) 851-2914

Fax

(717) 851-2479

NPI assigned

May 15, 2015

Last updated

Dec 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Rebecca Parker Other name

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Good Samaritan Physician ServicesGroup PAC ID 5496728172, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: afahnbulleh166503@wellspan.direct-ci.com

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.

• Good Samaritan Physician Services

  dba WellSpan Urology - Lebanon

  • Urology Physician
  • Lebanon, PA
  • NPI 1558749846
  Medicare reassignment Care Compare group NPD
• Good Samaritan Physician Services

  dba WellSpan Heart Failure Program

  • Cardiovascular Disease Physician
  • York, PA
  • NPI 1497521702
  NPD
• Good Samaritian Physician Services

  dba WellSpan Geriatrics

  • Geriatric Medicine (Internal Medicine) Physician
  • York, PA
  • NPI 1508632803
  NPD
• Good Samaritan Physician Services

  • Family Medicine Physician
  • Lebanon, PA
  • NPI 1326064460
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1477931012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-2914",
            "fax_number": "717-851-2479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S GEORGE ST FL 2",
            "city": "YORK",
            "state": "PA",
            "postal_code": "17403",
            "telephone_number": "717-851-2914",
            "fax_number": "717-851-2479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Trindle Rd",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170114413",
            "country_code": "US",
            "telephone_number": "717-412-7859",
            "fax_number": "717-965-3214",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4510 Marketplace Way",
            "address_purpose": "LOCATION",
            "city": "Enola",
            "state": "PA",
            "postal_code": "170252462",
            "country_code": "US",
            "telephone_number": "717-547-6108",
            "fax_number": "717-547-6189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 Trindle Rd",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170114413",
            "country_code": "US",
            "telephone_number": "717-412-7859",
            "fax_number": "717-965-3214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAHNBULLEH",
        "first_name": "ABA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-15",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SPO14415",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP014415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103274342",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "003566432",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "6376004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "PARKER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Chloe Ezelle, APRN
• Austin Michael Ezzone, MD
• Joshua Evan Fabie, MD
• Yetunde Fabiyi, DO,MS
• Nadege Toubou Fackche, M.D.
• Vivian C Faircloth, MD
• Faithful Hands Healthcare Services LLC
• Nazia Faiz-Qadir, M.D.
• Michael Joseph Falci, D.P.M.
• Shannon Kathryn Falci, PHARMD

• Family Nurse Practitioner in York, PA
• Providers in York, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.