Individual provider Active NPI

Colleen M Kivitz, CRNP

  • Adult Health Nurse Practitioner
  • Bryn Mawr, PA
National Provider Identifier
1508208133
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
SP013045 Issued in PA
Practice address
933 E Haverford Rd
Bryn Mawr, PA 19010-3819
Phone
(610) 649-6400
Fax
(610) 649-7971
NPI assigned
Jul 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X SP013045 PA Primary
Gerontology Nurse Practitioner 363LG0600X SP013045 PA

Addresses

Primary practice location

933 E Haverford Rd
Bryn Mawr, PA 19010-3819

Mailing address

933 E Haverford Rd
Bryn Mawr, PA 19010-3819
Phone (610) 649-6400

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
I20131023002164 PA Practitioner - Nurse Practitioner 9133354327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118

933 E Haverford Rd
Bryn Mawr, PA 19010-3819
Phone (484) 337-5250

Hospital & facility affiliations

  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP013045PAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare CurrentSince Aug 12, 2013 Accepting new patients

Locations

933 E Haverford Rd
Bryn Mawr, PA 19010
Phone (610) 527-3800

933 E Haverford Rd
#100
Bryn Mawr, PA 19010
Phone (610) 649-6400

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

Organizations & group practices 1

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 3

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": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415145600000",
    "number": "1508208133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 E HAVERFORD RD",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103819",
            "telephone_number": "610-649-6400",
            "fax_number": "610-649-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E HAVERFORD RD",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103819",
            "telephone_number": "610-649-6400",
            "fax_number": "610-649-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIVITZ",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-24",
        "last_updated": "2014-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP013045",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP013045",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

Verify at the official NPI Registry.