St. Luke'S Physician Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ST. LUKE'S PHYSICIAN GROUP, INC.

Practice address

2403 Butler St
Easton, PA 18042-5302

Phone

(484) 822-5405

NPI assigned

Jan 21, 2020

Organization subpart

No

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

Authorized official

Name

Ellen L Ettwein

Title

Enrollment Specialist

Phone

(484) 526-6048

Specialties & licenses 1

Addresses

Other names 1

• St. Luke's Internal Medicine Wilson Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1013547819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000",
            "telephone_number": "484-526-6048",
            "fax_number": "833-213-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 BUTLER ST",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180425302",
            "telephone_number": "484-822-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "ETTWEIN",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "484-526-6048"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Internal Medicine Wilson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Luke'S Physician Group Inc., Dba
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.

• All providers in Easton, PA
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; 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.