Individual provider Active NPI

Nicola Anne Fedorowicz, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1659926368
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA060885 Issued in PA
Practice address
3400 Spruce St
6 Dulles
Philadelphia, PA 19104-4238
Phone
(215) 662-4000
NPI assigned
Aug 8, 2019
Last updated
Sep 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Medical Physician Assistant 363AM0700X MA060885 PA Primary

Addresses

Primary practice location

3400 Spruce St
6 Dulles
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
6 Dulles
Philadelphia, PA 19104-4238
Phone (215) 662-4000

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
I20190829000641 PA Practitioner - Physician Assistant 1052649035 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, shared by 15 NPIs, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 615-5858

501 S 54TH St
Hospital Medicine Hup Cedar
Philadelphia, PA 19143-1900
Phone (215) 748-9707

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA060885PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Sep 2, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Sep 2, 2019 Accepting new patients

Locations

3400 Spruce St
Fl 6
Philadelphia, PA 19104
Phone (215) 615-0800

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

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1659926368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "6 DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "6 DULLES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOROWICZ",
        "first_name": "NICOLA",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA060885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.