Individual provider Active NPI

Stephanie Gregory, CRNP

  • Gerontology Nurse Practitioner
  • Allentown, PA
National Provider Identifier
1639708340
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP021677 Issued in PA
Practice address
1627 Chew St
Allentown, PA 18102-3648
Phone
(109) 693-3936
NPI assigned
Apr 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP021677 PA
Gerontology Nurse Practitioner 363LG0600X SP021677 PA Primary

Addresses

Primary practice location

1627 Chew St
Allentown, PA 18102-3648

Mailing address

2100 Mack Blvd FL 4
Allentown, PA 18103-5622
Phone (484) 884-4500

Other names 1

  • Stephanie Destafney Former name

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
I20201203000109 PA Practitioner - Nurse Practitioner 9032520697 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

17 TH and Chew St
Allentown, PA 18102
Phone (610) 402-3390

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP021677PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Nov 16, 2020 Accepting new patients
Lehigh Valley Physician Group Nurse Practitioner Current Accepting new patients
Lehigh Valley Physician Group CurrentSince Nov 16, 2020 Accepting new patients
Pulmonary Associates PC Past Accepting new patients

Locations

1627 Chew St
Allentown, PA 18102
Phone (610) 969-2388

2100 Mack Blvd
Fl 4
Allentown, PA 18103

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

642 State Route 93 Hwy
Sugarloaf, PA 18249
Phone (570) 708-1505

Organizations & group practices 5

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": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1639708340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD FL 4",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "484-884-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 CHEW ST",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181023648",
            "telephone_number": "109-693-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGORY",
        "first_name": "STEPHANIE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP021677",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP021677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "DESTAFNEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.