NPIMap

Organization Active NPI

Wellspan Medical Group

Doing business as WellSpan Family & Pediatric Medicine - Rothsville

  • Family Medicine Physician
  • Lititz, PA
National Provider Identifier
1154872661
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSPAN MEDICAL GROUP
Doing business as
WellSpan Family & Pediatric Medicine - Rothsville
Practice address
2320 Rothsville Rd
Suite 200
Lititz, PA 17543-8215
Phone
(717) 721-4800
Fax
(717) 626-1613
NPI assigned
Oct 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Authorized official

Name
Christina Moon
Title
Supervisor-Verification Services
Phone
(717) 851-1405

Specialties & licenses 1

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

Addresses

Primary practice location

2320 Rothsville Rd
Suite 200
Lititz, PA 17543-8215

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Other names 1

  • WellSpan Family & Pediatric Medicine - Rothsville 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 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1154872661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 ROTHSVILLE RD",
            "address_2": "SUITE 200",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175438215",
            "telephone_number": "717-721-4800",
            "fax_number": "717-626-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "SUPERVISOR-VERIFICATION SERVICES",
        "authorized_official_telephone_number": "717-851-1405"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Family & Pediatric Medicine - Rothsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lititz, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.