NPIMap

Individual provider Active NPI

Phillip Robert Peterson, M.D.

  • Emergency Medicine Physician
  • Lewisburg, PA
National Provider Identifier
1003137613
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD447379 Issued in PA
Practice address
One Hospital Drive
Lewisburg, PA 17837-9350
Phone
(570) 522-2640
Fax
(570) 768-3921
NPI assigned
Jun 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD447379 PA Primary
Hospitalist Physician 208M00000X MD447379 PA

Addresses

Primary practice location

One Hospital Drive
Lewisburg, PA 17837-9350

Mailing address

One Hospital Drive
Suite 306
Lewisburg, PA 17837-9350
Phone (570) 522-4110

Other identifiers 1

IdentifierTypeStateIssuer
1028234030003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130628000495 PA Practitioner - Emergency Medicine 8628218492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Ohio State University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians
Evangelical Medical Services OrganizationGroup PAC ID 9133033087, 255 clinicians

Practice addresses (Care Compare)

1 Hospital Dr
Lewisburg, PA 17837-9350
Phone (570) 522-4264

25 Monument Rd
York, PA 17403-5073

Hospital & facility affiliations

  • Wellspan Evangelical Community Hospital Hospital, Lewisburg, PA, CCN 390013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD447379PAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evangelical Medical Services Organization CurrentSince Feb 22, 2017 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Evangelical Medical Services Organization Hospitalist Current Accepting new patients
Evangelical Medical Services Organization CurrentSince Feb 22, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Dec 1, 2025 Accepting new patients
Wellspan Medical Group CurrentSince Dec 1, 2025 Accepting new patients

Locations

25 Lystra Rogers Dr
Lewisburg, PA 17837
Phone (570) 523-3290

1 Hospital Dr
Lewisburg, PA 17837
Phone (570) 522-2000

1 Hospital Dr
Ste 306
Lewisburg, PA 17837
Phone (570) 522-4110

3 Hospital Dr
Ste 206
Lewisburg, PA 17837
Phone (570) 522-9771

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

1600 S George St
York, PA 17403
Phone (717) 848-3615

Interoperability endpoints

  • Direct secure messaging: ppeterson485123@wellspan.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evangelical Community HospitalLewisburg, PA, CCN 390013 Hospital Corporate Officer Jan 1, 2024
Evangelical Community HospitalLewisburg, PA, CCN 39T013 Hospital Corporate Officer Jul 1, 2024
Wellspan Hospice ServicesLewisburg, PA, CCN 391545 Hospice Corporate Officer Jan 1, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 14

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1003137613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE HOSPITAL DRIVE",
            "address_2": "SUITE 306",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-522-4110",
            "fax_number": "570-768-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE HOSPITAL DRIVE",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-522-2640",
            "fax_number": "570-768-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PHILLIP",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD447379",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD447379",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028234030003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisburg, PA

Sources for this page

Verify at the official NPI Registry.