NPIMap

Individual provider Active NPI

Berhane Adhanom Gebreselasie, MD

  • Internal Medicine Physician
  • York, PA
National Provider Identifier
1164775433
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD455139 Issued in PA
Practice address
1001 S George St
3Rd Floor
York, PA 17403-3676
Phone
(717) 851-4005
Fax
(717) 812-2495
NPI assigned
Oct 23, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD455139 PA Primary

Addresses

Primary practice location

1001 S George St
3Rd Floor
York, PA 17403-3676

Mailing address

3450 Wayne Ave Apt 5G
Bronx, NY 10467-2518
Phone (917) 515-2344

Other identifiers 1

IdentifierTypeStateIssuer
103043499MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150818004213 PA Practitioner - HospitalistPractitioner - Internal Medicine 1759696974 Reassigns benefits to 1 organization
I20160727001357 NY Practitioner - Internal MedicinePractitioner - Hospitalist 1759696974 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Medical GroupGroup PAC ID 3779688650, 190 clinicians

Practice addresses (Care Compare)

2500 Bernville Rd
Reading, PA 19605-9453
Phone (610) 378-2000

Hospital & facility affiliations

  • Penn State Health St. Joseph Hospital, Reading, PA, CCN 390096
  • Milton S Hershey Medical Center Hospital, Hershey, PA, CCN 390256

Merit-based Incentive Payment System (MIPS)

Final score
79.31 of 100Reported as group
Quality
55.01
Promoting interoperability
99
Improvement activities
40
Cost
76.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital Internal Medicine Current Accepting new patients
Rochester General Hospital CurrentSince Jun 1, 2016 Accepting new patients
St. Joseph Medical Group CurrentSince Dec 1, 2020 Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Jun 1, 2016 Accepting new patients
St. Joseph Medical Group Internal Medicine CurrentSince Dec 1, 2020 Accepting new patients
Rochester General Hospital CurrentSince Jun 1, 2016 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince May 23, 2018 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince May 23, 2018 Accepting new patients
St Joseph Regional Health Network Past Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

178 Grandview Dr
Cobleskill, NY 12043
Phone (518) 254-3456

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

Interoperability endpoints

  • Direct secure messaging: bgebreselasie128971@direct-guthrie.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1164775433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 WAYNE AVE APT 5G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672518",
            "telephone_number": "917-515-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S GEORGE ST",
            "address_2": "3RD FLOOR",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033676",
            "telephone_number": "717-851-4005",
            "fax_number": "717-812-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEBRESELASIE",
        "first_name": "BERHANE",
        "middle_name": "ADHANOM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-23",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD455139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103043499",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.