Practitioner LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PRACTITIONER LLC

Doing business as

NP Medicine

Practice address

1200 Bustleton Pike Ste 16A3
Feasterville Trevose, PA 19053-4118

Phone

(267) 223-7738

Fax

(877) 416-0367

NPI assigned

Jun 25, 2019

Last updated

Jan 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Nino Kavtaradze, CRNPNPI 1639574841

Title

Primary Care Provider, Shareholder

Phone

(267) 223-7738

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NP Medicine Doing business as

Electronic endpoints 1

Locations

Interoperability endpoints

• Direct secure messaging: nkavtaradze@nm-pa.direct.office.nextgen.com

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nino Kavtaradze, CRNP

  • Nurse Practitioner
  • Feasterville Trevose, PA
  • NPI 1639574841
  Authorized official Same address or phone

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1497316996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 BUSTLETON PIKE STE 16A3",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190534118",
            "telephone_number": "267-223-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BUSTLETON PIKE STE 16A3",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190534118",
            "telephone_number": "267-223-7738",
            "fax_number": "877-416-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRACTITIONER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "KAVTARADZE",
        "authorized_official_first_name": "NINO",
        "authorized_official_title_or_position": "PRIMARY CARE PROVIDER, SHAREHOLDER",
        "authorized_official_telephone_number": "267-223-7738",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1037033750001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nkavtaradze@NM-PA.direct.office.nextgen.com",
            "affiliation": "N",
            "endpointDescription": "NEXTGEN EHR direct email adress",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1200 Bustleton Pike Ste 16A3",
            "city": "Feasterville Trevose",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190534118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "NP Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NP Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Jeanette Perrine-Mitchell, MS
• Arnold Pfannenstiel, D.D.S. ,F.A.G.D.
• Nishita Philip
• Solomia Ponomarenko, CRNP
• Brianna Postorino, MS, CCC-SLP
• Preferred Foot and Ankle Center PC
• Hapsatu Prendergast, MA, LBS
• Primary Choice Coordination LLC
• Professional Hospice Care, Inc.
• Promedeq Inc

• Primary Care Nurse Practitioner in Feasterville Trevose, PA
• Providers in Feasterville Trevose, PA by specialty
• Primary Care Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.