NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

  • Maternal & Fetal Medicine Physician
  • Fountain Hill, PA
National Provider Identifier
1003867623
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Practice address
701 Ostrum St
Suite 303
Fountain Hill, PA 18015-1155
Phone
(484) 526-3900
Fax
(866) 410-7401
NPI assigned
May 16, 2006
Last updated
Jan 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 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) 526-4911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine Physician 207VM0101X Primary

Addresses

Primary practice location

701 Ostrum St
Suite 303
Fountain Hill, PA 18015-1155

Mailing address

701 Ostrum St Ste 303
Fountain Hill, PA 18015-1152
Phone (484) 526-3900

Other practice location 1

701 Ostrum St
Suite 303
Fountain Hill, PA 18015-1155
Phone (484) 526-3900

Other identifiers 1

IdentifierTypeStateIssuer
1007307530188MedicaidPA

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

Locations

4051 Freemansburg Ave
Easton, PA 18045
Phone (484) 503-7474

Practitioners & affiliated clinicians

Practitioners 1,640

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 1,640

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1003867623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST STE 303",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151152",
            "telephone_number": "484-526-3900",
            "fax_number": "866-410-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 303",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "484-526-3900",
            "fax_number": "866-410-7401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Ostrum St",
            "address_2": "Suite 303",
            "address_purpose": "LOCATION",
            "city": "Fountain Hill",
            "state": "PA",
            "postal_code": "180151155",
            "country_code": "US",
            "telephone_number": "484-526-3900",
            "fax_number": "484-526-3908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-01-24",
        "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": "484-526-4911"
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007307530188",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.