NPIMap

Individual provider Active NPI

Olivia Carrasquillo, NP

  • Gerontology Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1669827572
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP015904 Issued in PA
Practice address
3998 Red Lion Road
Suite 240
Philadelphia, PA 19114
Phone
(215) 632-3500
Fax
(215) 632-6335
NPI assigned
Apr 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X SP015904 PA Primary

Addresses

Primary practice location

3998 Red Lion Road
Suite 240
Philadelphia, PA 19114

Mailing address

10 Presidential Blvd
Suite 124
Bala Cynwyd, PA 19004-1107
Phone (610) 664-9700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160610000412 PA Practitioner - Nurse Practitioner 7416247002 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

333 Cottman Ave
Philadelphia, PA 19111-2434
Phone (215) 707-2111

Hospital & facility affiliations

  • Temple University Hospital Hospital, Philadelphia, PA, CCN 390027
  • Hospital of the Fox Chase Cancer Center Hospital, Philadelphia, PA, CCN 390196

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP015904PAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Mar 3, 2024 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 3, 2024 Accepting new patients
Regional Gastroenterology Associates of Lancaster, LTD. CurrentSince Mar 1, 2022 Accepting new patients
Regional Gastroenterology Associates of Lancaster, LTD. CurrentSince Mar 1, 2022 Accepting new patients
Midatlantic Endoscopy LLC Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

10 Presidential Blvd
Ste 124
Bala Cynwyd, PA 19004
Phone (610) 664-9700

2112 Harrisburg Pike
Ste 202
Lancaster, PA 17601
Phone (717) 544-3500

840 Town Center Dr
Langhorne, PA 19047
Phone (215) 321-7221

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

10800 Knights Rd
Ste 240
Philadelphia, PA 19114
Phone (215) 632-3500

1331 E Wyoming Ave
Philadelphia, PA 19124
Phone (215) 537-7400

3500 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3656

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

100 E Lancaster Ave
Ste 252
Wynnewood, PA 19096
Phone (610) 896-7360

Organizations & group practices 7

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 9

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": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1669827572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PRESIDENTIAL BLVD",
            "address_2": "SUITE 124",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041107",
            "telephone_number": "610-664-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 RED LION ROAD",
            "address_2": "SUITE 240",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19114",
            "telephone_number": "215-632-3500",
            "fax_number": "215-632-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASQUILLO",
        "first_name": "OLIVIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-28",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP015904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.