Individual provider Active NPI

Nicole Sara Cournoyer, PA-C

  • Physician Assistant
  • Bryn Mawr, PA
National Provider Identifier
1831412873
Registry record updated Aug 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA054094 Issued in PA
Practice address
825 Old Lancaster Rd Ste 440
Bryn Mawr, PA 19010-3236
Phone
(610) 525-4511
Fax
(610) 525-8561
NPI assigned
Mar 4, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA054094 PA Primary

Addresses

Primary practice location

825 Old Lancaster Rd Ste 440
Bryn Mawr, PA 19010-3236

Mailing address

825 Old Lancaster Rd Ste 320
Bryn Mawr, PA 19010-3235
Phone (610) 527-3800

Other practice location 1

3400 Spruce Street
Philadelphia, PA 19104
Phone (215) 615-5858

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
I20120809000206 PA Practitioner - Physician Assistant 0345496279 Reassigns benefits to 1 organization

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
Bryn Mawr Medical Specialists AssociationGroup PAC ID 4183610934, 135 clinicians

Practice addresses (Care Compare)

825 Old Lancaster Rd
Suite 320
Bryn Mawr, PA 19010-3235
Phone (610) 527-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA054094PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bryn Mawr Medical Specialists Association CurrentSince Jun 27, 2024 Accepting new patients

Locations

825 Old Lancaster Rd
Ste 320
Bryn Mawr, PA 19010
Phone (610) 524-3800

825 Old Lancaster Rd
Ste 440
Bryn Mawr, PA 19010
Phone (610) 525-4511

130 S Bryn Mawr Ave
Fl 2
Bryn Mawr, PA 19010
Phone (610) 526-3000

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754697600000",
    "number": "1831412873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 OLD LANCASTER RD STE 320",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103235",
            "telephone_number": "610-527-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 OLD LANCASTER RD STE 440",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103236",
            "telephone_number": "610-525-4511",
            "fax_number": "610-525-8561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce Street",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-615-5858",
            "fax_number": "610-526-8561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COURNOYER",
        "first_name": "NICOLE",
        "middle_name": "SARA",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-04",
        "last_updated": "2025-08-09",
        "certification_date": "2025-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA054094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

Verify at the official NPI Registry.