Individual provider Active NPI

Thomas M Mextorf, D.O.

  • Family Medicine Physician
  • Lancaster, PA
National Provider Identifier
1194703629
Registry record updated Oct 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS006227L Issued in PA
Practice address
2221 Noll Dr Ste 2000
Lancaster, PA 17603-7614
Phone
(717) 715-1001
Fax
(717) 431-2321
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS006227L PA Primary

Addresses

Primary practice location

2221 Noll Dr Ste 2000
Lancaster, PA 17603-7614

Mailing address

2221 Noll Dr
Ste 2000
Lancaster, PA 17603-7610
Phone (717) 715-1001

Other identifiers 1

IdentifierTypeStateIssuer
0011392930010MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS006227LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penn State Health Medical Group, LLC Current Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Sep 13, 2018 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Penn State Health Medical Group, LLC PastSince Dec 9, 2019 Accepting new patients

Locations

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

2221 Noll Dr
Ste 2000
Lancaster, PA 17603
Phone (717) 715-1001

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1194703629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 NOLL DR",
            "address_2": "STE 2000",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176037610",
            "telephone_number": "717-715-1001",
            "fax_number": "717-431-2321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 NOLL DR STE 2000",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176037614",
            "telephone_number": "717-715-1001",
            "fax_number": "717-431-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEXTORF",
        "first_name": "THOMAS",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS006227L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011392930010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.