Active NPI
Stephanie Shull Diclemente, P.A.
- Medical Physician Assistant
- Broomall, PA
National Provider Identifier
1821311440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA054104
- Practice address
- 1999 Sproul Rd
Ste 25
Broomall, PA 19008-3508 - Phone
- (610) 353-6400
- Fax
- (610) 356-1204
- NPI assigned
- Mar 10, 2010
- Last updated
- Feb 9, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA054104 | PA | Primary |
Addresses
Primary practice location
1999 Sproul Rd
Ste 25
Broomall, PA 19008-3508
Mailing address
1999 Sproul Rd
Ste 25
Broomall, PA 19008-3508
Phone (610) 353-6400
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1991 Sproul Rd
Broomall, PA 19008-3518
830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Newtown Square, PA
- NPI 1922077643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644364800000",
"number": "1821311440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1999 SPROUL RD",
"address_2": "STE 25",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083508",
"telephone_number": "610-353-6400",
"fax_number": "610-356-1204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1999 SPROUL RD",
"address_2": "STE 25",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083508",
"telephone_number": "610-353-6400",
"fax_number": "610-356-1204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICLEMENTE",
"first_name": "STEPHANIE",
"middle_name": "SHULL",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-10",
"last_updated": "2022-02-09",
"certification_date": "2022-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA054104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broomall, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.