Individual provider Active NPI

Marilyn Jimenez, CRNP

  • Acute Care Nurse Practitioner
  • Reading, PA
National Provider Identifier
1962970640
Registry record updated Nov 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP09482 Issued in PA
Practice address
2500 Bernville Rd
Reading, PA 19605-9453
Phone
(484) 201-4488
NPI assigned
Nov 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP09482 PA Primary

Addresses

Primary practice location

2500 Bernville Rd
Reading, PA 19605-9453

Mailing address

2500 Bernville Rd
Reading, PA 19605-9453

Other identifiers 1

IdentifierTypeStateIssuer
SP019482MedicaidPA

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
I20190130001175 PA Practitioner - Nurse Practitioner 6002153947 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Medical GroupGroup PAC ID 3779688650, 190 clinicians

Practice addresses (Care Compare)

2500 Bernville Rd
Reading, PA 19605-9453
Phone (610) 378-2000

Hospital & facility affiliations

  • Penn State Health St. Joseph Hospital, Reading, PA, CCN 390096
  • Milton S Hershey Medical Center Hospital, Hershey, PA, CCN 390256

Merit-based Incentive Payment System (MIPS)

Final score
79.31 of 100Reported as group
Quality
55.01
Promoting interoperability
99
Improvement activities
40
Cost
76.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP09482PAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Medical Group Current Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Jan 1, 2021 Accepting new patients
St. Joseph Medical Group CurrentSince Jan 7, 2019 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients

Locations

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

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1541894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541894400000",
    "number": "1962970640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 BERNVILLE RD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196059453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 BERNVILLE RD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196059453",
            "telephone_number": "484-201-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "MARILYN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-11",
        "last_updated": "2018-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP09482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SP019482",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reading, PA

Sources for this page

Verify at the official NPI Registry.