NPIMap

Individual provider Active NPI

Cynthia Wagner, NP

  • Gerontology Nurse Practitioner
  • West Chester, PA
National Provider Identifier
1861768970
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP011729 Issued in PA
Practice address
440 E Marshall St Ste 201
West Chester, PA 19380-5414
Phone
(610) 738-2500
NPI assigned
Mar 23, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP011729 PA
Gerontology Nurse Practitioner 363LG0600X SP011729 PA Primary

Addresses

Primary practice location

440 E Marshall St Ste 201
West Chester, PA 19380-5414

Mailing address

440 E Marhsall St
Ste 201
West Chester, PA 19380-5415
Phone (610) 738-2500

Other identifiers 1

IdentifierTypeStateIssuer
440771OtherPAMLHC MEDICARE GROUP AA #

Other names 1

  • Cynthia Wagner Avellino Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121008000326 PA Practitioner - Nurse Practitioner 2860641859 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
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 Civic Ctr Blvd
Philadelphia, PA 19104-5127

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP011729PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Aug 14, 2017 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Aug 14, 2017 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Current Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst CurrentSince Aug 14, 2017 Accepting new patients
University of Penn-Medical Group CurrentSince Aug 14, 2017 Accepting new patients

Locations

3400 Civic Center Blvd
#2
Philadelphia, PA 19104
Phone (215) 615-0063

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

440 E Marshall St
Ste 201
West Chester, PA 19380
Phone (610) 738-2500

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 5

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 6

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": "1332460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1861768970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 E MARHSALL ST",
            "address_2": "STE 201",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193805415",
            "telephone_number": "610-738-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E MARSHALL ST STE 201",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193805414",
            "telephone_number": "610-738-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CYNTHIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP011729",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP011729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MLHC MEDICARE GROUP AA #",
            "identifier": "440771",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "AVELLINO",
            "middle_name": "WAGNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Chester, PA

Sources for this page

Verify at the official NPI Registry.