Individual provider Active NPI

Kelly Dirocco, CRNP

  • Adult Health Nurse Practitioner
  • King of Prussia, PA
National Provider Identifier
1821842980
Registry record updated Oct 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
SP028988 Issued in PA
Practice address
120 Valley Green LN Ste 510
King of Prussia, PA 19406-2080
Phone
(484) 324-7171
NPI assigned
Apr 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP028988 PA
Adult Health Nurse Practitioner 363LA2200X SP028988 PA Primary

Addresses

Primary practice location

120 Valley Green LN Ste 510
King of Prussia, PA 19406-2080

Mailing address

PO Box 412
Valley Forge, PA 19481-0412

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
I20240702003744 PA Practitioner - Nurse Practitioner 3577007467 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
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

120 Valley Green Lane
Suite 510
King of Prussia, PA 19406
Phone (484) 324-7100

Hospital & facility affiliations

  • Paoli Hospital Hospital, Paoli, PA, CCN 390153
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Bryn Mawr Rehabilitation Hospital Inpatient rehabilitation facility, Malvern, PA, CCN 393025

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP028988PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Nurse Practitioner CurrentSince Aug 1, 2024 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

120 Valley Green Ln
Ste 510
King of Prussia, PA 19406
Phone (484) 324-7100

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728777600000",
    "number": "1821842980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412",
            "city": "VALLEY FORGE",
            "state": "PA",
            "postal_code": "194810412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 VALLEY GREEN LN STE 510",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062080",
            "telephone_number": "484-324-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIROCCO",
        "first_name": "KELLY",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-10-13",
        "certification_date": "2024-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP028988",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP028988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

Verify at the official NPI Registry.