Active NPI
Devon Fennelly, CRNP
- Adult Health Nurse Practitioner
- Malvern, PA
National Provider Identifier
1962235713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- SP029362
- Practice address
- 414 Paoli Pike
Malvern, PA 19355-3311 - Phone
- (484) 596-5981
- NPI assigned
- Aug 26, 2024
- Last updated
- Aug 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | SP029362 | PA | |
| Primary Care Nurse Practitioner | 363LP2300X | SP029362 | PA | |
| Adult Health Nurse Practitioner | 363LA2200X | SP029362 | PA | Primary |
Addresses
Primary practice location
414 Paoli Pike
Malvern, PA 19355-3311
Mailing address
404 Flagstone Cir
Coatesville, PA 19320-1682
Other practice location 1
11 Industrial Blvd
Paoli, PA 19301-1632
Phone (610) 467-8910
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
414 Paoli Pike
Malvern, PA 19355-3311
Phone (484) 596-5254
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabilitation Associates of the Main Line, P.C. | Current | Accepting new patients | |
| Medical Associates of the Main Line, PC | Past | Accepting new patients |
Locations
414 Paoli Pike
Malvern, PA 19355
Phone (484) 596-5254
Interoperability endpoints
- devon.fennelly.1@554.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Physical Medicine & Rehabilitation Physician
- Malvern, PA
- NPI 1538230396
-
- Hospitalist Physician
- Malvern, PA
- NPI 1033276076
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- West Chester, PA
- NPI 1356333579
-
dba Lankenau Hospital
- General Acute Care Hospital
- Wynnewood, PA
- NPI 1245335629
-
dba Bryn Mawr Rehabilitation Hospital
- Rehabilitation Hospital
- Malvern, PA
- NPI 1396850368
Inpatient rehabilitation facility
-
dba Bryn Mawr Hospital
- General Acute Care Hospital
- Bryn Mawr, PA
- NPI 1508971441
-
dba Hospital of the University of Pennsylvania
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1851370910
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1962235713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 FLAGSTONE CIR",
"city": "COATESVILLE",
"state": "PA",
"postal_code": "193201682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 PAOLI PIKE",
"city": "MALVERN",
"state": "PA",
"postal_code": "193553311",
"telephone_number": "484-596-5981"
}
],
"practiceLocations": [
{
"address_1": "11 Industrial Blvd",
"address_purpose": "LOCATION",
"city": "Paoli",
"state": "PA",
"postal_code": "193011632",
"country_code": "US",
"telephone_number": "610-467-8910",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FENNELLY",
"first_name": "DEVON",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-26",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "PA",
"license": "SP029362",
"primary": false
},
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "PA",
"license": "SP029362",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "PA",
"license": "SP029362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malvern, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.