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MRS. PAULINE S COUSINEAU
NPI 1538426424
Nurse Practitioner - Adult Health in West Grove, PA

Active since April 16, 2012PECOS EnrolledAccepts Medicare Assignment
1011 W BALTIMORE PIKE, SUITE 304, WEST GROVE, PA 19390(610) 869-1278 Get Directions Write a Review

NPPES record last updated: April 16, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mrs. Pauline S Cousineau NPPES

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

MRS. PAULINE S COUSINEAU (NPI 1538426424) is an individual adult health provider in West Grove, Pennsylvania, licensed in Pennsylvania (SP012053) and active in the NPI registry since April 2012. She is enrolled in Medicare PECOS, is affiliated with Union Hospital Of Cecil County, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1538426424
Entity TypeIndividualFemale
Primary Taxonomy363LA2200X
Provider Legal NameMRS. PAULINE S COUSINEAU
Location Address1011 W BALTIMORE PIKE, SUITE 304West Grove, PA 19390-9446
Mailing Address111 Cromwell DrLincoln University, PA 19352-1120 · (610) 999-9441
Phone(610) 869-1278
Sole ProprietorYes
Medical School CMSOtherGraduated 2012
Enumeration DateApril 16, 2012
✔ NPI 1538426424 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
License✔ Licensed in PA · SP012053
1011 W BALTIMORE PIKE, West Grove, PA 19390
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Other Names 1

Former Name (1)Miss Pauline K Spaetzel Np

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from NH Healthy Families, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Pauline S Cousineau 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 ID8628231826
PECOS Enrollment IDI20230228000288
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.

Medicare Billing Reassignments

3

Medicare enrollment records show Pauline Cousineau reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Christiana Care Health Services Inc
Same address
Cardiovascular Disease
1011 W BALTIMORE PIKE, SUITE 304
West Grove, PA 19390
  • Reassigned Medicare billing, Pennsylvania and Delaware enrollments
  • Also billed through NPI 1134104565 (Delaware)
  • 186 clinicians in this Medicare group
NPI 1659547560 (610) 869-1278
West Grove Clinic Company LLC
Same address
Family Medicine
1011 W BALTIMORE PIKE STE 304
West Grove, PA 19390
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 106 clinicians in this Medicare group
NPI 1790856078 (610) 869-1278
Union Hospital Of Cecil County, Inc.
15 mi
Family Medicine
103 NORTH EAST PLZ
North East, MD 21901
  • Reassigned Medicare billing, Maryland enrollment
  • 512 clinicians in this Medicare group
NPI 1174374102 (410) 287-5570

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-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.
251 services155 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
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.
208 services136 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
138 services126 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
115 services112 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
58 services57 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
56 services56 patients

Hospital Affiliations CMS Care Compare

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

Union Hospital Of Cecil County

Acute Care Hospitals · Elkton, MD
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number210032
Location106 Bow StreetElkton, MD 21921 · Cecil County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19390 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
5%226 patients1/55-star benchmark: 85%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%834 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
96%1,209 patients4/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
100%102 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
86%596 patients4/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
29%491 patients2/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 245 patients
93%245 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
75%596 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
4%596 patients1/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
8%596 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

WEST GROVE HOSPITAL CORPORATION
Orthopaedic Surgery
1011 W BALTIMORE PIKE, SUITE 112
WEST GROVE, PA 19390
Chester County (610) 869-1565
CARTY EYE ASSOCIATES, LTD.
Ophthalmology
1011 W BALTIMORE PIKE, SUITE 211
WEST GROVE, PA 19390
Chester County (610) 869-0200
JENNERSVILLE MEDICAL ASSOCIATES, PC
Internal Medicine
1011 W BALTIMORE PIKE, SUITE 301
WEST GROVE, PA 19390
Chester County (610) 869-3620
ABIGAIL TWERDOK CNM
Advanced Practice Midwife
1011 W BALTIMORE PIKE, SUITE 208
WEST GROVE, PA 19390
Chester County (610) 869-2220
INTERNAL MEDICINE ASSOCIATES, P C
Internal Medicine (Adolescent Medicine)
1011 W BALTIMORE PIKE, SUITE 301
WEST GROVE, PA 19390
Chester County (610) 869-3620
OLD BALTIMORE PIKE APOTHECARY INC
Pharmacy (Community/Retail Pharmacy)
1011 W BALTIMORE PIKE, STE 109
WEST GROVE, PA 19390
Chester County (610) 869-3200
CHESTER COUNTY EYE CARE ASSOCIATES, PC
Ophthalmology
1011 W BALTIMORE PIKE, SUITE 303
WEST GROVE, PA 19390
Chester County (610) 696-1230
JENNSERVILLE OBSTETRICS AND GYNECOLOGY, LLC
Obstetrics & Gynecology
1011 W BALTIMORE PIKE, SUITE 102
WEST GROVE, PA 19390
Chester County (610) 896-8919

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 Pauline Cousineau's NPI number?

The NPI number for Pauline Cousineau is 1538426424. It was assigned to this individual provider in the NPPES registry on April 16, 2012. The provider is also known as Miss Pauline K Spaetzel Np.

Where is Pauline Cousineau located?

Pauline Cousineau practices at 1011 W Baltimore Pike Suite 304, West Grove, PA 19390. The listed phone number is (610) 869-1278.

What is Pauline Cousineau's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Pauline Cousineau enrolled in Medicare?

Yes. Pauline Cousineau 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.

Which organizations bill Medicare for Pauline Cousineau's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Pauline Cousineau reassigns Medicare benefits to 3 organizations: Christiana Care Health Services Inc (West Grove, PA), West Grove Clinic Company LLC (West Grove, PA) and Union Hospital Of Cecil County, Inc. (North East, MD). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Pauline Cousineau's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Pauline Cousineau accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from NH Healthy Families and Ambetter from Sunflower Health Plan list Pauline Cousineau 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 Pauline Cousineau affiliated with any hospitals?

According to CMS data, Pauline Cousineau is affiliated with Union Hospital Of Cecil County.

When was this NPI record last updated?

The NPPES record for Pauline Cousineau was last updated on April 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.