NPIMap

Organization Active NPI

Northern Lancaster County Medical Group

  • Family Medicine Physician
  • Ephrata, PA
National Provider Identifier
1073547733
Registry record updated May 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Practice address
808 Pleasantview Dr
Ephrata, PA 17522-1644
Phone
(717) 733-9090
Fax
(717) 733-8982
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2015

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

Authorized official

Name
Charles David Noll, DO
Title
Vice President
Phone
(717) 851-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

808 Pleasantview Dr
Ephrata, PA 17522-1644

Mailing address

4131 Oregon Pike
Suite C
Ephrata, PA 17522-9550
Phone (717) 859-5161

Other identifiers 3

IdentifierTypeStateIssuer
1013977730013MedicaidPA
DD6938OtherPARAILROAD MEDICARE
1746358OtherPABLUE SHIELD

Other names 1

  • Wellspan Family Medicine - Trout Run Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432771200000",
    "number": "1073547733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 OREGON PIKE",
            "address_2": "SUITE C",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175229550",
            "telephone_number": "717-859-5161",
            "fax_number": "717-859-5169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 PLEASANTVIEW DR",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221644",
            "telephone_number": "717-733-9090",
            "fax_number": "717-733-8982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LANCASTER COUNTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-05-28",
        "status": "A",
        "authorized_official_last_name": "NOLL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-851-5161",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013977730013",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD6938",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1746358",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspan Family Medicine - Trout Run",
            "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 May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.