NPIMap

Organization Active NPI

Wellspan Medical Group

Doing business as WellSpan Breast Surgery

  • Surgery Physician
  • Ephrata, PA
National Provider Identifier
1073166963
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
WELLSPAN MEDICAL GROUP
Doing business as
WellSpan Breast Surgery
Practice address
804 Grandview Dr Ste 2
Ephrata, PA 17522-1681
Phone
(717) 639-2955
Fax
(717) 461-7443
NPI assigned
Jul 19, 2019
Last updated
Sep 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Authorized official

Name
Jennifer Sweitzer
Title
Credentialing Coordinator
Phone
(717) 851-6838

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X NU
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

804 Grandview Dr Ste 2
Ephrata, PA 17522-1681

Mailing address

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

Other practice location 1

735 Norman Dr Ste B
Lebanon, PA 17042-7559
Phone (717) 639-2955

Other practice location 2

35 Erick Rd
Lancaster, PA 17601-3111
Phone (717) 639-2955

Other practice location 3

210 Jpm Rd Ste 202
Lewisburg, PA 17837-9367
Phone (570) 522-4200

Other practice location 4

450 S Washington St
Gettysburg, PA 17325-2500
Phone (717) 709-6599

Other practice location 5

22 St Paul Dr Ste 207
Chambersburg, PA 17201-1036
Phone (717) 709-6599

Other names 1

  • WellSpan Breast Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000815 PA Part B Supplier - Clinic/Group Practice 1951213115 Receives reassigned benefits from 3,390 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1073166963",
    "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": "804 GRANDVIEW DR STE 2",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221681",
            "telephone_number": "717-639-2955",
            "fax_number": "717-461-7443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "735 Norman Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427559",
            "country_code": "US",
            "telephone_number": "717-639-2955",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "35 Erick Rd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176013111",
            "country_code": "US",
            "telephone_number": "717-639-2955",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 Jpm Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Lewisburg",
            "state": "PA",
            "postal_code": "178379367",
            "country_code": "US",
            "telephone_number": "570-522-4200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "450 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Gettysburg",
            "state": "PA",
            "postal_code": "173252500",
            "country_code": "US",
            "telephone_number": "717-709-6599",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22 St Paul Dr Ste 207",
            "address_purpose": "LOCATION",
            "city": "Chambersburg",
            "state": "PA",
            "postal_code": "172011036",
            "country_code": "US",
            "telephone_number": "717-709-6599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-19",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "SWEITZER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-851-6838"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Breast Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellSpan Breast Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ephrata, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; 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.