Individual provider Active NPI

Kathryn Elizabeth Fenwick, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1790408615
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP025952 Issued in PA
Practice address
3400 Civic Center Blvd
1St Floor, West Pavilion
Philadelphia, PA 19104
Phone
(215) 662-3202
NPI assigned
Sep 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP025952 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
1St Floor, West Pavilion
Philadelphia, PA 19104

Mailing address

3400 Civic Center Blvd
1St Floor, West Pavilion
Philadelphia, PA 19104
Phone (215) 662-3202

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kathryn.fenwick@pennmedicine.upenn.edu Direct

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
I20221013001099 PA Practitioner - Nurse Practitioner 2365818507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Jefferson Medical College of Thomas Jefferson University, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd 1St
Harron Lung Pcam
Philadelphia, PA 19104-4306
Phone (215) 662-3202

Hospital & facility affiliations

  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
  • Christiana Hospital Hospital, Newark, DE, CCN 080001
  • Chester County Hospital Hospital, West Chester, PA, CCN 390179

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
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Nov 21, 2022 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 21, 2022 Accepting new patients

Locations

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

3400 Civic Center Blvd
Fl 1
Philadelphia, PA 19104
Phone (215) 615-5864

3737 Market St
#10
Philadelphia, PA 19104
Phone (215) 662-8766

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 5

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": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1790408615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1ST FLOOR, WEST PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1ST FLOOR, WEST PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENWICK",
        "first_name": "KATHRYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Miss",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP025952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kathryn.fenwick@pennmedicine.upenn.edu",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "3400 Civic Center Blvd",
            "address_2": "1st Floor, West Pavilion",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "19104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.