Individual provider Active NPI

Kirstin Liu, CRNP

  • Family Nurse Practitioner
  • Media, PA
National Provider Identifier
1720488208
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP014359 Issued in PA
Practice address
1098 W Baltimore Pike
Suite 3404 Riddle Health Center 3
Media, PA 19063-5139
Phone
(610) 627-4170
Fax
(610) 627-4224
NPI assigned
Sep 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP014359 PA Primary

Addresses

Primary practice location

1098 W Baltimore Pike
Suite 3404 Riddle Health Center 3
Media, PA 19063-5139

Mailing address

1098 W Baltimore Pike
Suite 3404 Riddle Health Center 3
Media, PA 19063-5139
Phone (610) 627-4170

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
I20141216000321 PA Practitioner - Nurse Practitioner 0244553659 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare CurrentSince Nov 3, 2014 Accepting new patients
Riddle Healthcare Associates PastSince Nov 3, 2014 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

1098 W Baltimore Pike
Ste 3404
Media, PA 19063
Phone (610) 627-4170

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

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.

NPI Registry JSON

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1720488208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1098 W BALTIMORE PIKE",
            "address_2": "SUITE 3404 RIDDLE HEALTH CENTER 3",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635139",
            "telephone_number": "610-627-4170",
            "fax_number": "610-627-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1098 W BALTIMORE PIKE",
            "address_2": "SUITE 3404 RIDDLE HEALTH CENTER 3",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635139",
            "telephone_number": "610-627-4170",
            "fax_number": "610-627-4224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "KIRSTIN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-03",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP014359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Media, PA

Sources for this page

Verify at the official NPI Registry.