Individual provider Active NPI

Stephanie Waldron, PA-C

  • Physician Assistant
  • Mount Holly, NJ
National Provider Identifier
1912545294
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00555100 Issued in NJ
Practice address
175 Madison Ave
Mount Holly, NJ 08060-2099
Phone
(609) 914-6000
Fax
(609) 914-6182
NPI assigned
Dec 17, 2019
Last updated
Oct 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 25MP00555100 NJ
Physician Assistant 363A00000X 25MP00555100 NJ Primary

Addresses

Primary practice location

175 Madison Ave
Mount Holly, NJ 08060-2099

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

218A Sunset Rd
Willingboro, NJ 08046-1110
Phone (609) 835-3655

Other practice location 2

1600 Haddon Ave
Camden, NJ 08103-3101
Phone (856) 757-3500

Other practice location 3

218 Sunset Rd
Willingboro, NJ 08046-1110
Phone (609) 835-3056

Other practice location 4

100 Bowman Dr Lowr Level1
Voorhees, NJ 08043-9612
Phone (856) 247-3000

Other practice location 5

90 Brick Rd Fl 3
Marlton, NJ 08053-2177
Phone (856) 355-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address swaldron111281@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20200207001756 NJ Practitioner - Physician Assistant 9537595681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

100 Bowman Dr
Voorhees, NJ 08043-9612
Phone (856) 247-7260

1600 Haddon Ave
Camden, NJ 08103-3101

175 Madison Ave
Mount Holly, NJ 08060-2038

218 Sunset Rd
FL 5
Willingboro, NJ 08046-1110
Phone (609) 444-0359

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Feb 10, 2020 Accepting new patients
Virtua Medical Group, PA Physician Assistant CurrentSince Feb 10, 2020 Accepting new patients
Virtua Medical Group, PA Hospitalist Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

90 Brick Rd
Fl 3
Marlton, NJ 08053
Phone (856) 247-2160

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

100 Bowman Dr
Lowr
Voorhees, NJ 08043
Phone (856) 247-3000

Interoperability endpoints

  • Direct secure messaging: swaldron111281@directvirtua.org

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1912545294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MADISON AVE",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602099",
            "telephone_number": "609-914-6000",
            "fax_number": "609-914-6182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "218A Sunset Rd",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-835-3655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 Haddon Ave",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081033101",
            "country_code": "US",
            "telephone_number": "856-757-3500",
            "fax_number": "856-365-4088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "218 Sunset Rd",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-835-3056",
            "fax_number": "856-835-5741",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Bowman Dr Lowr Level1",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080439612",
            "country_code": "US",
            "telephone_number": "856-247-3000",
            "fax_number": "856-247-2597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "90 Brick Rd Fl 3",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "080532177",
            "country_code": "US",
            "telephone_number": "856-355-6000",
            "fax_number": "856-355-6731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDRON",
        "first_name": "STEPHANIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-17",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NJ",
            "license": "25MP00555100",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00555100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swaldron111281@directvirtua.org",
            "affiliation": "N",
            "address_1": "218A Sunset Rd",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Holly, NJ

Sources for this page

Verify at the official NPI Registry.