NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

  • Pulmonary Disease Physician
  • East Stroudsburg, PA
National Provider Identifier
1003349424
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Practice address
239 E Brown St
East Stroudsburg, PA 18301-3005
Phone
(570) 421-3872
Fax
(570) 424-6631
NPI assigned
Apr 4, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dean W Evans
Title
President
Phone
(484) 526-4991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

239 E Brown St
East Stroudsburg, PA 18301-3005

Mailing address

239 E. Brown Street
East Stroudsburg, PA 18301-3005
Phone (570) 421-3872

Other practice location 1

239 E Brown St
East Stroudsburg, PA 18301-3005
Phone (570) 421-3872

Other practice location 2

516 Jenna Dr
Brodheadsville, PA 18322-7141
Phone (272) 272-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1003349424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 E. BROWN STREET",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013005",
            "telephone_number": "570-421-3872",
            "fax_number": "570-424-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 E BROWN ST",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013005",
            "telephone_number": "570-421-3872",
            "fax_number": "570-424-6631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "239 E Brown St",
            "address_purpose": "LOCATION",
            "city": "East Stroudsburg",
            "state": "PA",
            "postal_code": "183013005",
            "country_code": "US",
            "telephone_number": "570-421-3872",
            "fax_number": "570-424-6631",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "516 Jenna Dr",
            "address_purpose": "LOCATION",
            "city": "Brodheadsville",
            "state": "PA",
            "postal_code": "183227141",
            "country_code": "US",
            "telephone_number": "272-272-3200",
            "fax_number": "833-536-5294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-04",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-4991"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Stroudsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.