Jennifer G Shoup, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP011318 Issued in PA

Practice address

5039 Swamp Rd
Suite 401
Fountainville, PA 18923-9667

Phone

(215) 230-8380

Fax

(215) 230-8370

NPI assigned

Apr 25, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Peace Valley Internal Medicine PC

  • Internal Medicine Physician
  • Fountainville, PA
  • NPI 1578658928
  Medicare reassignment NPD

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1962793059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5039 SWAMP ROAD",
            "address_2": "SUITE 401",
            "city": "FOUNTAINVILLE",
            "state": "PA",
            "postal_code": "18923",
            "telephone_number": "215-230-8380",
            "fax_number": "215-230-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5039 SWAMP RD",
            "address_2": "SUITE 401",
            "city": "FOUNTAINVILLE",
            "state": "PA",
            "postal_code": "189239667",
            "telephone_number": "215-230-8380",
            "fax_number": "215-230-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOUP",
        "first_name": "JENNIFER",
        "middle_name": "G",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-25",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP011318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace Valley Internal Medicine PC
• Susan M Purcell, MD
• Stephanie Lynn Pusateri, OTR/L, CHT
• Lisa Rhodes, D.P.M.
• Robert Edward Rinaldi, M.D.
• Elizabeth Z. Smyser, ED.M.
• Kathleen B Tapper, CRNA
• Kristin J Tatrow, PH.D.
• Melissa A Taylor, CRNP
• Tara Lynn Verdolini, CRNP

• Adult Health Nurse Practitioner in Fountainville, PA
• Providers in Fountainville, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.