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NINO KAVTARADZE CRNP
NPI 1639574841
Nurse Practitioner in Feasterville Trevose, PA

Active since October 30, 2014PECOS Enrolled
1200 BUSTLETON PIKE STE 16A3, FEASTERVILLE TREVOSE, PA 19053(267) 574-5236 Get Directions Write a Review

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 29, 2020, Jul 2, 2019 (2 updates tracked since 2019).

About Nino Kavtaradze Crnp NPPES

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

NINO KAVTARADZE CRNP (NPI 1639574841) is an individual nurse practitioner in Feasterville Trevose, Pennsylvania, licensed in Pennsylvania (SP015632) and active in the NPI registry since October 2014. She is enrolled in Medicare PECOS and maintains a secondary practice location in Philadelphia.

NPPES Registry Identity

NPI1639574841
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameNINO KAVTARADZECredential: CRNP
Location Address1200 BUSTLETON PIKE STE 16A3Feasterville Trevose, PA 19053-4118
Mailing Address1200 Bustleton Pike Ste 16a3Feasterville Trevose, PA 19053-4118 · (267) 223-7738 · Fax (267) 223-7738
Phone(267) 574-5236
Sole ProprietorNo
Enumeration DateOctober 30, 2014
Last NPPES UpdateNovember 27, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 29, 2020
✔ NPI 1639574841 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in PA · SP015632
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedRegistered NurseTaxonomy 163W00000X · License RN632493 (PA)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License SP015632 (PA)
1200 BUSTLETON PIKE STE 16A3, Feasterville Trevose, PA 19053
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Secondary Practice Location 1

Location 111043 Greiner RdPhiladelphia, PA 19116-2611 · Phone (267) 574-5236

Other Identifiers 4

Medicaid1032670520017PA
OtherSP015632PA · Pennsylvania Department Of State
OtherRN632493PA · Pennsylvania Department Of State
Other33402683American Nurses Credentialing Center (ancc)

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nino Kavtaradze Crnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Nino Kavtaradze reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Infinite Medical PC
222 mi
Family Medicine
7 CREEK LN
Bristol, RI 02809
  • Reassigned Medicare billing, New York enrollment
  • 188 clinicians in this Medicare group
NPI 1407483175 (718) 964-6161

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19053 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

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

PRACTITIONER LLC
Nurse Practitioner (Primary Care)
1200 BUSTLETON PIKE STE 16A3
FEASTERVILLE TREVOSE, PA 19053
Bucks County (267) 223-7738

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 Nino Kavtaradze's NPI number?

The NPI number for Nino Kavtaradze is 1639574841. It was assigned to this individual provider in the NPPES registry on October 30, 2014.

Where is Nino Kavtaradze located?

Nino Kavtaradze practices at 1200 Bustleton Pike Ste 16a3, Feasterville Trevose, PA 19053. The listed phone number is (267) 574-5236.

What is Nino Kavtaradze's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Nino Kavtaradze enrolled in Medicare?

Yes. Nino Kavtaradze is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nino Kavtaradze's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nino Kavtaradze reassigns Medicare benefits to Infinite Medical PC (Bristol, RI). The 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 Nino Kavtaradze's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nino Kavtaradze was last updated on November 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.