NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc

Doing business as St. Luke's General Surgery Miners

  • Surgery Physician
  • Coaldale, PA
National Provider Identifier
1124685425
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC
Doing business as
St. Luke's General Surgery Miners
Practice address
360 W Ruddle St
Coaldale, PA 18218-1027
Phone
(484) 526-2200
Fax
(484) 526-2398
NPI assigned
May 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Tami Giglio
Title
Enrollment Specialist
Phone
(484) 526-3571

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X

Addresses

Primary practice location

360 W Ruddle St
Coaldale, PA 18218-1027

Mailing address

801 Ostrum St
Bethlehem, PA 18015-1000
Phone (484) 526-3571

Other practice location 1

211 N 12th St
Lehighton, PA 18235-1138
Phone (610) 377-1300

Other identifiers 1

IdentifierTypeStateIssuer
034134OtherPAMEDICARE

Other names 1

  • St. Luke's General Surgery Miners Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

2650 Woodglen Rd
Ste 300
Pottsville, PA 17901
Phone (484) 526-2244

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1124685425",
    "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": "484-526-3571",
            "fax_number": "833-213-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W RUDDLE ST",
            "city": "COALDALE",
            "state": "PA",
            "postal_code": "182181027",
            "telephone_number": "484-526-2200",
            "fax_number": "484-526-2398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 N 12th St",
            "address_purpose": "LOCATION",
            "city": "Lehighton",
            "state": "PA",
            "postal_code": "182351138",
            "country_code": "US",
            "telephone_number": "610-377-1300",
            "fax_number": "570-645-1661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "GIGLIO",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "484-526-3571"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "034134",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's General Surgery Miners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Luke's General Surgery Miners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coaldale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.