Individual provider Active NPI

Bruck A Yemenu, MD

  • Internal Medicine Physician
  • Hershey, PA
National Provider Identifier
1194045609
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MT197456 Issued in PA
Practice address
500 University Dr
Hershey, PA 17033-2360
Phone
(717) 531-8521
NPI assigned
Jun 7, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2010

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 MT197456 PA Primary

Addresses

Primary practice location

500 University Dr
Hershey, PA 17033-2360

Mailing address

500 University Dr
Hershey, PA 17033-2360
Phone (717) 531-8521

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130830000714 PA Practitioner - Internal Medicine 1850534314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lancaster General HospitalGroup PAC ID 1254240039, 520 clinicians

Practice addresses (Care Compare)

555 N Duke St
Lancaster, PA 17602-2250

Hospital & facility affiliations

  • Lancaster General Hospital Hospital, Lancaster, PA, CCN 390100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT197456PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Hospital Internal Medicine CurrentSince Aug 19, 2013 Accepting new patients
Lancaster General Hospital CurrentSince Aug 19, 2013 Accepting new patients
Lancaster General Medical Group Past Accepting new patients
Lancaster General Hospital Past Accepting new patients

Locations

555 N Duke St
Lancaster, PA 17602
Phone (717) 544-5945

Organizations & group practices 4

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 3

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": "1275868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1194045609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEMENU",
        "first_name": "BRUCK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT197456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hershey, PA

Sources for this page

Verify at the official NPI Registry.