NPIMap

Organization Active NPI

Philhaven

Doing business as WellSpan Philhaven

  • Psychiatry Physician
  • Lebanon, PA
National Provider Identifier
1043316441
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PHILHAVEN
Doing business as
WellSpan Philhaven
Practice address
283 S Butler Rd
Lebanon, PA 17042-8939
Phone
(717) 270-2443
NPI assigned
Sep 15, 2006
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Mantha Kotsalos
Title
VP & President Philhaven
Phone
(717) 270-2423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

283 S Butler Rd
Lebanon, PA 17042-8939

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other names 1

  • WellSpan Philhaven Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000103 PA Part B Supplier - Clinic/Group Practice 8729991419 Receives reassigned benefits from 156 practitioners
2 other NPIs on this enrollment
Practice locations: Lebanon, PA; Lancaster, PA; Ephrata, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Philhaven

    dba WellSpan Philhaven

    • Psychiatric Hospital
    • Lebanon, PA
    • NPI 1972598076

    8729991419

    Same PAC ID

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

964 Isabel Dr
Lebanon, PA 17042
Phone (717) 274-9777

Practitioners & affiliated clinicians

Practitioners 164

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 164

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1043316441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 S BUTLER RD",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170428939",
            "telephone_number": "717-270-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILHAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "KOTSALOS",
        "authorized_official_first_name": "MANTHA",
        "authorized_official_title_or_position": "VP & PRESIDENT PHILHAVEN",
        "authorized_official_telephone_number": "717-270-2423"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Philhaven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.