Individual provider Active NPI

Jayme Elizabeth Taylor, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1578989281
Registry record updated May 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP013689 Issued in PA
Practice address
3400 Civic Center Blvd
West Pavilion, 4TH Floor
Philadelphia, PA 19104-5127
Phone
(215) 662-2300
NPI assigned
Mar 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP013689 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
West Pavilion, 4TH Floor
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
West Pavilion, 4TH Floor
Philadelphia, PA 19104-5127
Phone (215) 662-2300

Other names 1

  • Jayme Elizabeth Ewanichak Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180129000201 NY Practitioner - Nurse Practitioner 0244461549 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
342149NYMDLicensed Practical Nurse
SP013689PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Mar 6, 2014 Accepting new patients
North Shore-Lij Medical PC CurrentSince Nov 8, 2017 Accepting new patients
University of Penn-Medical Group CurrentSince Mar 6, 2014 Accepting new patients

Locations

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

300 Community Dr
Plandome, NY 11030

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1578989281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "WEST PAVILION, 4TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "WEST PAVILION, 4TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "JAYME",
        "middle_name": "ELIZABETH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-06",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP013689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAYME",
            "last_name": "EWANICHAK",
            "middle_name": "ELIZABETH",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.