Wellspan Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WELLSPAN MEDICAL GROUP

Doing business as

Brockie Internal Medicine

Practice address

924 Colonial Ave Ste B
York, PA 17403-3450

Phone

(717) 845-8623

Fax

(717) 843-6682

NPI assigned

Apr 27, 2006

Last updated

Aug 10, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Amy F Wilkinson

Title

Credentialing Coordinator

Phone

(717) 851-1405

Specialties & licenses 5

Addresses

Other identifiers 17

Other names 1

• Brockie Internal Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 41

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.

• Alexi Achenbach, MD

  • Gynecology Physician
  • Lebanon, PA
  • NPI 1932397452
  NPD
• Mohammed Zulfequar Ali, M.D.

  • Hospitalist Physician
  • Gettysburg, PA
  • NPI 1497751853

  Internal Medicine

  NPD
• Kimberlee Bardo, CRNA

  • Certified Registered Nurse Anesthetist
  • Allentown, PA
  • NPI 1215374079
  NPD
• Kaitlyn Bingaman

  • Medical Physician Assistant
  • Chambersburg, PA
  • NPI 1740747823
  NPD
• Waseem Butt, MD

  • Gastroenterology Physician
  • Newtown, PA
  • NPI 1346304847

  Internal Medicine

  NPD
• Holly Cooper Thatcher, MA, LPC

  • Professional Counselor
  • York, PA
  • NPI 1548653579
  NPD
• Morgan E Garman, PAC

  • Medical Physician Assistant
  • Lebanon, PA
  • NPI 1033750583
  NPD
• Bonnie Urquhart Gruenberg, RN CNM CRNP

  • Advanced Practice Midwife
  • Ephrata, PA
  • NPI 1639270150
  NPD
• Drew A. Hampton, CRNA

  • Certified Registered Nurse Anesthetist
  • Allenwood, PA
  • NPI 1093071110
  NPD
• Mary Laura Hitchcock, CRNP

  • Women's Health Nurse Practitioner
  • York, PA
  • NPI 1124072988
  NPD
• Roxanna Rodriguez Llanos, DO

  • Internal Medicine Physician
  • Montgomeryville, PA
  • NPI 1538320031
  NPD
• Theodore Robert Sullivan, M.D.

  • Vascular Surgery Physician
  • Abington, PA
  • NPI 1144216938
  NPD

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1215994934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 MOUNT ROSE AVE",
            "address_2": "SUITE B3",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033051",
            "telephone_number": "717-851-1405",
            "fax_number": "717-843-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 COLONIAL AVE STE B",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033450",
            "telephone_number": "717-845-8623",
            "fax_number": "717-843-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-851-1405",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "03005700",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "DJ3Q",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "059784",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100721360243",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH COLONIAL AVE",
            "identifier": "1142285",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERI 65PA GEORGE ST",
            "identifier": "0068498000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN HOPKINS",
            "identifier": "800174",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERI 65PA COLONIAL",
            "identifier": "0068498001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON COLONIAL AVE",
            "identifier": "82194",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON GEORGE ST",
            "identifier": "82201",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA3246",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5126007",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007721360092",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GEORGE ST",
            "identifier": "20010095",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER SP",
            "identifier": "354T",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1519824",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER PCP",
            "identifier": "S1EM",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brockie Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wellspan Medical Group (Wellspan Pediatric Hospitalists)
• Wellspan Medical Group (Wellspan Neonatology)
• Wellspan Medical Group (WellSpan Orthopedics)
• Wellspan Medical Group (WellSpan Neurosurgery)
• Wellspan Medical Group (WellSpan Radiology and Radiation Oncology)
• Wellspan Medical Group (WellSpan Dental - Hoodner)
• Wellspan Medical Group (WellSpan Pulmonary and Sleep Medicine)
• Wellspan Medical Group (WellSpan Medical Oncology and Hematology at York Cancer Center)
• Wellspan Medical Group (Wellspan Family Medicine - Hayshire)
• Wellspan Medical Group (Wellspan Plastic Surgery)

• Internal Medicine Physician in York, PA
• Providers in York, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; 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.