MASERAY FOFANAH (FNP) – Family Nurse Practitioner, NPI 1215638465

Family Nurse Practitioner

MASERAY FOFANAH (FNP) is a healthcare provider. based in Springfield, Pennsylvania. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. 1068830 (TX). The NPI Number for MASERAY FOFANAH (FNP) is 1215638465

Main info

Female

Sole Proprietor

5 Years Of Experience

Accepts Medicare Assignment

Name

MASERAY FOFANAH (FNP)

NPI

1215638465

Phone

(161) 076-6149

Address

257 N STATE RD APT 25A

Enumeration Date

14 March 2023

Last Update Date

14 March 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

4126648860

Graduation Year

2021 (5 years ago)

PAC ID

7012406465

Group Practice PAC ID

6709030133

Professional Enrollment ID

I20251027004472

Address ID

PA151322712MC100XXSTXX300

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience30

Completeness75

Years active:3State licenses:1Digital endpointsOther names

7,509 NURSE PRACTITIONER in AZ

Provider Addresses for MASERAY FOFANAH (FNP)

257 N STATE RD APT 25A
SPRINGFIELD, PA 190641826
Phone: (161) 076-6149
Type: Mailing
1717 W NORTHERN AVE STE 211
PHOENIX, AZ 850215469
Phone: (480) 249-2655
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-10-27

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

Medicare enrolled
On CMS revalidation list
Due date assigned
Revalidate in PECOS

CMS enrollment records

Enrollment ID	Type	Specialty	State	Due date
I20251027004472	I	Nurse Practitioner	PA	TBD

What to do next

No action required while the due date shows TBD.
Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 19064)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 6709030133View full group profile

Name	Specialty	State
RALPH RICHARD AIKEN	Nurse Practitioner	PA
JACQUELINE LEIGH FORD (NP)	Nurse Practitioner	PA
MR. ALEXANDER S GOCH (CRNP)	Nurse Practitioner	PA
ALEXANDER AYONBO OBORO (CRNP)	Nurse Practitioner	PA
MRS. STEFANIE CAVALLO (CRNP)	Nurse Practitioner	PA
COURTNEY MARIE POPWELL (DNP)	-	GA
MARY RATHER	-	NC
EDWARD BYRON EPPES	Nurse Practitioner	AL