Individual provider Active NPI

Michael A Pisa, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1790967073
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN578860 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 662-3487
NPI assigned
Nov 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

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 RN578860 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 531-2399

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
I20080109000382 PA Practitioner - Nurse Practitioner 2163502691 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN578860PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
University of Penn-PA Trauma Past Accepting new patients

Locations

3400 Spruce St
Fl 3
Philadelphia, PA 19104

3400 Spruce St
#818
Philadelphia, PA 19104

Organizations & group practices 4

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": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1790967073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-531-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PISA",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-29",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "RN578860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.