Individual provider Active NPI

Mary Flick Eni, CRNP

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1790566412
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP028201 Issued in PA
Practice address
3400 Spruce Street
3 Ravdin BLDG. Ste. F
Philadelphia, PA 19104-4206
Phone
(215) 662-3202
Fax
(215) 349-8432
NPI assigned
Oct 9, 2023
Last updated
Jul 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP028201 PA Primary

Addresses

Primary practice location

3400 Spruce Street
3 Ravdin BLDG. Ste. F
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce Street
3 Ravdin BLDG. Ste. F
Philadelphia, PA 19104-4206
Phone (215) 662-3202

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
I20240130002970 PA Practitioner - Nurse Practitioner 4981057536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
FL 3
Philadelphia, PA 19104-4229
Phone (215) 662-3202

777 Township Line Rd
Suite 150
Yardley, PA 19067-5567
Phone (215) 860-3360

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince Dec 23, 2023 Accepting new patients
University of Penn-Medical Group CurrentSince Dec 23, 2023 Accepting new patients

Locations

3400 Spruce St
Fl 3
Philadelphia, PA 19104

3400 Spruce St
Ste F
Philadelphia, PA 19104
Phone (215) 662-3823

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

777 Township Line Rd
Ste 150
Yardley, PA 19067
Phone (215) 860-3360

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1790566412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 RAVDIN BLDG. STE. F",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3202",
            "fax_number": "215-349-8432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 RAVDIN BLDG. STE. F",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3202",
            "fax_number": "215-349-8432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENI",
        "first_name": "MARY",
        "middle_name": "FLICK",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP028201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.