ANNETTE M SEXTON CRNP
NPI 1154826337
Nurse Practitioner - Acute Care in Paoli, PA
NPI Status: Active since March 28, 2018
Contact Information
21 INDUSTRIAL BLVD
STE 205
PAOLI, PA
ZIP 19301
Phone: (610) 284-8500
- Individual
- Female
- Years of Experience 9
- Nurse Practitioner
- Acute Care
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About ANNETTE SEXTON
This page provides the complete NPI Profile along with additional information for Annette Sexton, a provider established in Paoli, Pennsylvania with a medical specialization in Nurse Practitioner, focusing in acute care and more than 9 years of experience. The healthcare provider is registered in the NPI registry with number 1154826337 assigned on March 2018. The practitioner's primary taxonomy code is 363LA2100X with license number SP018090 (PA). The provider is registered as an individual and her NPI record was last updated 7 years ago.
- NPI
- 1154826337
- Provider Name
- ANNETTE M SEXTON CRNP
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 21 INDUSTRIAL BLVD STE 205 PAOLI, PA 19301
- Location Phone
- (610) 284-8500
- Mailing Address
- 21 INDUSTRIAL BLVD STE 205 PAOLI, PA 19301
- Mailing Phone
- (610) 284-8500
- Medical School Name
- OTHER
- Graduation Year
- 2017
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-28-2018
- Last Update Date
- 10-09-2019
- Code Navigator
A nurse practitioner (NP) like Annette Sexton is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Secondary Locations
- 501 N Lansdowne Ave
Drexel Hill, PA 19026
(610) 284-8500
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Acute Care
- Taxonomy Code
- 363LA2100X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- SP018090
- License State
- PA
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- my Blue Access Major Events Select PPO Catastrophic 10600 - 3 Free PCP Visits - PPO
- my Blue Access Select PPO Bronze 3800 - PPO
- my Blue Access Select PPO Bronze 3800 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Bronze 9200 - PPO
- my Blue Access Select PPO Gold 0 - PPO
- my Blue Access Select PPO Gold 0 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Gold 1700 HSA - PPO
- my Blue Access Select PPO Premier Gold 0 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Premier Platinum 0 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Premier Silver 0 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Standard Bronze 7500 - PPO
- my Blue Access Select PPO Standard Gold 2000 - PPO
- my Blue Access Select PPO Standard Gold 2000 + Adult Dental and Vision - PPO
- my Blue Access Select PPO Standard Platinum 0 - PPO
- my Blue Access Select PPO Standard Silver 6000 - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Annette Sexton is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Annette Sexton is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 6406190610
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20181128003499
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 17 times for 15 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 13 times for 13 patientsFollow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
This service was performed 47 times for 38 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $23.17 for a new patient copayment and $26.3 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 19301 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $92.69
- Minimum New Patient Price $59.88
- Maximum New Patient Price $180.99
- Average New Patient Copayment $23.17
- Minimum New Patient Copayment $14.97
- Maximum New Patient Copayment $45.24
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $105.21
- Minimum Established Patient Price $19.3
- Maximum Established Patient Price $147.29
- Average Established Patient Copayment $26.3
- Minimum Established Patient Copayment $4.82
- Maximum Established Patient Copayment $36.82
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Annette Sexton is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| PAOLI HOSPITAL | 255 WEST LANCASTER AVENUE PAOLI, PA 19301 | (610) 648-1000 | Acute Care Hospitals |
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1154826337, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 17 providers are registered at the same or a nearby location.
PAOLI, PA 19301
PAOLI, PA 19301
PAOLI, PA 19301
PAOLI, PA 19301
PAOLI, PA 19301
PAOLI, PA 19301
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154826337, enumerated as an "individual" on March 28, 2018.
The provider is located at 21 INDUSTRIAL BLVD STE 205 PAOLI, PA 19301 and the phone number is (610) 284-8500.
Nurse Practitioner with taxonomy code 363LA2100X and a focus in Acute Care.
The provider might be accepting Accepts: Highmark Blue Cross Blue Shield Delaware. Please consult your insurance carrier or call the provider to verify.
Annette Sexton is affiliated with: PAOLI HOSPITAL.
