Nino Kavtaradze, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP015632 Issued in PA

Practice address

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

Phone

(267) 574-5236

NPI assigned

Oct 30, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  Nurse Practitioner, NY

  Medicare reassignment NPD

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1639574841",
    "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",
            "fax_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": "267-574-5236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11043 Greiner Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191162611",
            "country_code": "US",
            "telephone_number": "267-574-5236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAVTARADZE",
        "first_name": "NINO",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-30",
        "last_updated": "2023-11-27",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN632493",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP015632",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP015632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032670520017",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA DEPARTMENT OF STATE",
            "identifier": "SP015632",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA DEPARTMENT OF STATE",
            "identifier": "RN632493",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN NURSES CREDENTIALING CENTER (ANCC)",
            "identifier": "33402683",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Nkavtaradze@NM-PA.direct.office.nextgen.com",
            "affiliation": "Y",
            "endpointDescription": "NEXTGEN EHR direct email adress",
            "affiliationName": "PRACTITIONER LLC",
            "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": []
}

• Joyce M Grabar
• Judy Anderson, MD, PC
• John Bernard Junod, M.D.
• Michael Kenneth Kaner, D.M.D.
• Gilbert Kasirsky, D.O.
• Denise Keegan, CRNP
• Morgan Kern, MS, OTR
• Kelli Margaret Kerner, MA CCC/SLP
• Raymond E Key I
• Anna Keylin

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.