Individual provider Active NPI

Alice May Isidro, PA-C

  • Surgical Physician Assistant
  • Wynnewood, PA
National Provider Identifier
1720167034
Registry record updated Oct 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA002647L Issued in PA
Practice address
100 E Lancaster Ave
JD Lankenau Pavillion, Mezzanine
Wynnewood, PA 19096-3450
Phone
(484) 476-1000
Fax
(484) 476-9000
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA002647L PA Primary

Addresses

Primary practice location

100 E Lancaster Ave
JD Lankenau Pavillion, Mezzanine
Wynnewood, PA 19096-3450

Mailing address

100 E Lancaster Ave
JD Lankenau Pavillion, Mezzanine
Wynnewood, PA 19096-3450
Phone (484) 476-1000

Other names 1

  • Alice May Bernabe Isidro Other 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
I20070130000151 PA Practitioner - Physician Assistant 0749281020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1100 Walnut St
Mob 5TH Floor
Philadelphia, PA 19107-5563
Phone (215) 955-6750

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of the University of Pennsylvania Past Accepting new patients

Organizations & group practices 2

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 1

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445212800000",
    "number": "1720167034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "address_2": "JD LANKENAU PAVILLION, MEZZANINE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "484-476-1000",
            "fax_number": "484-476-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "address_2": "JD LANKENAU PAVILLION, MEZZANINE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "484-476-1000",
            "fax_number": "484-476-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISIDRO",
        "first_name": "ALICE",
        "middle_name": "MAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2015-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA002647L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "BERNABE ISIDRO",
            "middle_name": "MAY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.