Individual provider Active NPI

Alyssa Justine Adam, CRNP

  • Family Nurse Practitioner
  • Lancaster, PA
National Provider Identifier
1922858166
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP028474 Issued in PA
Practice address
2221 Noll Dr
Lancaster, PA 17603-7614
Phone
(717) 715-1001
NPI assigned
Mar 22, 2024
Last updated
Mar 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP028474 PA Primary

Addresses

Primary practice location

2221 Noll Dr
Lancaster, PA 17603-7614

Mailing address

843 Westbrooke Dr
Elizabethtown, PA 17022-8837
Phone (570) 573-9270

Other names 1

  • Alyssa Justine Porter Former name

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
I20240416003361 PA Practitioner - Nurse Practitioner 9931548484 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

Practice addresses (Care Compare)

2221 Noll Dr
Suite 2000
Lancaster, PA 17603-7614
Phone (717) 715-1001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP028474PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Penn State Health Medical Group, LLC CurrentSince May 1, 2024 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince May 1, 2024 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

2221 Noll Dr
Ste 2000
Lancaster, PA 17603
Phone (717) 715-1001

Organizations & group practices 4

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 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": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1922858166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 WESTBROOKE DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170228837",
            "telephone_number": "570-573-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 NOLL DR",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176037614",
            "telephone_number": "717-715-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAM",
        "first_name": "ALYSSA",
        "middle_name": "JUSTINE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP028474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "PORTER",
            "middle_name": "JUSTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.