NPIMap

Organization Active NPI

St Luke's Physician Group Inc

Doing business as St. Luke's Childrens' Choice Pediatrics

  • Pediatrics Physician
  • Fountain Hill, PA
National Provider Identifier
1093321622
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ST LUKE'S PHYSICIAN GROUP INC
Doing business as
St. Luke's Childrens' Choice Pediatrics
Practice address
514 Delaware Ave
Fountain Hill, PA 18015-1104
Phone
(610) 865-6545
Fax
(610) 758-9595
NPI assigned
Sep 18, 2020
Last updated
Sep 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Authorized official

Name
Dean Evans
Title
President
Phone
(484) 526-5731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

514 Delaware Ave
Fountain Hill, PA 18015-1104

Mailing address

514 Delaware Ave
Fountain Hill, PA 18015-1104
Phone (610) 865-6545

Other names 1

  • St. Luke's Childrens' Choice Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2123493St Luke's Children's Choice Pediatrics514 Delaware Avenue, Bethlehem, PA 18015Certificate of waiverDec 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Surgical Assoc165 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1093321622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 DELAWARE AVE",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151104",
            "telephone_number": "610-865-6545",
            "fax_number": "610-758-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 DELAWARE AVE",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151104",
            "telephone_number": "610-865-6545",
            "fax_number": "610-758-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S PHYSICIAN GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-5731"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Childrens' Choice Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.