Jacqueline Gavin
Individual provider Active NPI Certified Registered Nurse Anesthetist · Glenolden, PA
NPI 1760807275 · NPPES record last updated Feb 20, 2014
Key facts
- NPI
- 1760807275
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 100723 (PA)
- Practice address
- 808 Oakwood Dr
Glenolden, PA 19036-1614 - Phone
- (610) 209-4145
- NPI assigned
- Feb 20, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Anesthesia Services PA
Practice addresses (Care Compare)
100 Wilmington W Chester Pike
Suite 100
Chadds Ford, PA 19317-9040
Phone (610) 672-4900
4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 733-1000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140804001789 | PA | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 9830316579 | Reassigns benefits to 3 organizations |
| I20240328001657 | DE | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 9830316579 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100723 | PA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associates in Anesthesia, Inc. | Current |
Accepting new patients | |
| Chadds Ford Ambulatory Surgical Center, LLC | Current |
Accepting new patients | |
| Anesthesia Services PA | Current |
Accepting new patients | |
| Ridley Crossings Surgical Center | Past | Accepting new patients | |
| Associates in Anesthesia | Past | Accepting new patients |
Locations
4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700
2600 Glasgow Ave
Ste 226
Newark, DE 19702
Phone (302) 836-3539
1212 Baltimore Pike
Ste 200
Chadds Ford, PA 19317
Phone (610) 874-4147
100 Wilmington W Chester Pike
Ste 100
Chadds Ford, PA 19317
Phone (610) 672-4900
30 Medical Center Blvd
Ste 305
Chester, PA 19013
Phone (610) 619-7411
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/0d26bd04-9128-4f58-8e6d-ffda5cd00f89/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 100723 | PA | Yes |
Addresses
Primary practice location
808 Oakwood Dr
Glenolden, PA 19036-1614
Mailing address
808 Oakwood Dr
Glenolden, PA 19036-1614
Phone (610) 209-4145
Other names
- Jacqueline Gavin
Other providers in Glenolden, PA
- Eye Site
- Larry Eric Farmer
- Donna Marie Fedena
- Cynthia Theresa Fehrle
- Shawn Frampton
- John H. Geovjian
- Paul Gideon
- Glenolden Medical Associates, LTD.
- Good Enough Therapy Services, LLC
- Kent T Ha
All providers in Glenolden, PA · Certified Registered Nurse Anesthetist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.