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MARY FANNON
NPI 1043933518
Nurse Practitioner - Acute Care in Philadelphia, PA

Active since September 20, 2022PECOS EnrolledAccepts Medicare Assignment
111 S 11TH ST, PHILADELPHIA, PA 19107(215) 955-6060 Get Directions Write a Review

NPPES record last updated: September 20, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Fannon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY FANNON (NPI 1043933518) is an individual acute care provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP026285) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS, is affiliated with Thomas Jefferson University Hospital, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1043933518
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameMARY FANNON
Location Address111 S 11TH STPhiladelphia, PA 19107-4824
Mailing Address2437 Ardsley AveGlenside, PA 19038-3701 · (215) 806-3284
Phone(215) 955-6060
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateSeptember 20, 2022
NPPES CertifiedSeptember 19, 2022
✔ NPI 1043933518 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in PA · SP026285
111 S 11TH ST, Philadelphia, PA 19107
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Fannon is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254708316
PECOS Enrollment IDI20221101003420
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Thomas Jefferson University Hospital

Acute Care Hospitals · Philadelphia, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390174
Location111 South 11th StreetPhiladelphia, PA 19107 · Philadelphia County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE LYNN RENALDI D.O.
Anesthesiology
111 S 11TH ST, SUITE 8490
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6161
LING FAN
Nurse Practitioner (Acute Care)
111 S 11TH ST, GIBBON BLDG., SUITE 6270
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-8304
WILLIAM JUSTICE MD
Student in an Organized Health Care Education/Training Program
111 S 11TH ST
PHILADELPHIA, PA 19107
Philadelphia County (215) 995-6000
DR. DAVID P. FRIEDMAN M.D.
Radiology (Diagnostic Radiology)
111 S 11TH ST, SUITE 3390
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-2900
DR. WALTER K. KRAFT M.D.
Internal Medicine
111 S 11TH ST, SUITE 6270
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6540
DR. TAKI GALANIS M.D.
Internal Medicine
111 S 11TH ST, SUITE 6270
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6540
DR. STEVEN M LUDWIN M.D.
Internal Medicine
111 S 11TH ST, SUITE 2170
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6610
JENNIFER L SWOPE CRNA
Nurse Anesthetist, Certified Registered
111 S 11TH ST, SUITE 8490
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6161

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Fannon's NPI number?

The NPI number for Mary Fannon is 1043933518. It was assigned to this individual provider in the NPPES registry on September 20, 2022.

Where is Mary Fannon located?

Mary Fannon practices at 111 S 11th St, Philadelphia, PA 19107. The listed phone number is (215) 955-6060.

What is Mary Fannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Mary Fannon enrolled in Medicare?

Yes. Mary Fannon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Mary Fannon accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Mary Fannon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Mary Fannon affiliated with any hospitals?

According to CMS data, Mary Fannon is affiliated with Thomas Jefferson University Hospital.

When was this NPI record last updated?

The NPPES record for Mary Fannon was last updated on September 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.