NPIMap

Organization Active NPI

Upmc Williamsport

Doing business as Williamsport Regional Medical Center SPU- Divine Providence Campus

  • Ambulatory Surgical Clinic/Center
  • Williamsport, PA
National Provider Identifier
1225500770
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
UPMC WILLIAMSPORT
Doing business as
Williamsport Regional Medical Center SPU- Divine Providence Campus
Practice address
1100 Grampian Blvd
Williamsport, PA 17701-1909
Phone
(570) 326-8000
NPI assigned
Dec 21, 2018
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Christopher Stockhausen
Title
Cfo
Phone
(412) 578-9592

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1100 Grampian Blvd
Williamsport, PA 17701-1909

Mailing address

600 Grant St, US Steel Tower, 59TH Floor
C/O Renee Johnson
Pittsburgh, PA 15219-2740
Phone (412) 623-6303

Other identifiers 1

IdentifierTypeStateIssuer
1007548350043MedicaidPA

Other names 1

  • Williamsport Regional Medical Center SPU- Divine Providence Campus Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL uconnect.upmc.com Other
Direct Messaging Address UPMCHospitals@upmcdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071211000513 PA Part A Provider - Hospital 3678473550 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williamsport, PA; Muncy, PA; Montoursville, PA; Lock Haven, PA; Lewisburg, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225500770. Details of each certification follow.

Hospital certification: CCN 390045

Legal name
UPMC WILLIAMSPORT
Doing business as
WILLIAMSPORT REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 14, 2026
Beds
255 (222 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 30, 1873 in PA
Enrollment address
700 High St
Hospital Inpatient & Outpatient Services
Williamsport, PA 17701-3100
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Upmc WilliamsportCCN 390045 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Williamsport Hosp Lab9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

215 E Water St
Muncy, PA 17756
Phone (570) 327-8137

1705 Warren Ave
Williamsport, PA 17701
Phone (570) 320-7470

449 River Ave
Williamsport, PA 17701
Phone (570) 320-7458

740 High St
Ste 2001
Williamsport, PA 17701
Phone (570) 321-2805

Ownership & related parties

All disclosed owners & managing parties 29

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jamie L Adam Individual Corporate DirectorBoard Member Jan 1, 2023
John Dennis Murray Individual Corporate DirectorBoard Member Jan 1, 2023
Patrick Wilson Individual Corporate DirectorBoard Member Jun 9, 2009
Susan Ann Branton Individual Corporate DirectorBoard Member Sep 1, 2016
Donald M Yealy Individual Corporate DirectorBoard Member Jan 1, 2023
Upmc Susquehanna Organization, Williamsport, PA Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Mar 24, 2008 100%
Other Mar 24, 2008 100%
Patricia Jackson Gehris Individual Corporate DirectorAssistant Secretary Feb 21, 2025
Davie J Gilmour Individual Corporate DirectorChair Sep 1, 2016
Tamra Minnier Individual Corporate DirectorBoard Member Aug 15, 2023
Jill a Burns Individual Corporate DirectorBoard Member Jan 1, 2023
Daniel a Klingerman Individual Corporate DirectorBoard Member Sep 1, 2016
Patrick Larsen Individual Corporate OfficerBoard Member Non Voting Apr 11, 2025
Josh Costa Individual Corporate DirectorBoard Member, Non-Voting Jan 1, 2023
Teresa Ann Jacobs Individual Corporate DirectorSecretary Sep 1, 2016
Keith Kuzio Individual Corporate DirectorBoard Member Jan 1, 2023
David P Gibbons Individual Corporate DirectorBoard Member Jan 1, 2023
Alfredo Blas Individual Corporate DirectorBoard Member Jun 30, 2022
Michael C Gerst Individual Corporate DirectorBoard Member Apr 28, 2023
Joel Philip Yuhas Individual Corporate OfficerBoard Member Apr 28, 2023
Ronald Enrico Disimone Individual Corporate DirectorBoard Member Sep 1, 2016
Alana Huck Individual Corporate DirectorBoard Member Jan 1, 2023
Roger C Yost Individual Corporate OfficerCfo/Assistant Treasurer Aug 15, 2022
W-2 Managing EmployeeCfo Aug 15, 2022
Elizabeth Ritter Individual Corporate DirectorBoard Member Apr 11, 2025
Upmc Organization, Pittsburgh, PA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2016 100%
Other Oct 1, 2016
Glenn B Poirier Individual Corporate DirectorBoard Member Jan 1, 2023
Kim Zynn Individual Corporate DirectorBoard Member Jan 1, 2023
Eileen Simmons Individual Corporate DirectorBoard Member Jan 1, 2023
Ann S Pepperman Individual Corporate DirectorVice Chair Sep 1, 2016
Philip H Johnson Individual Corporate DirectorTreasurer Sep 1, 2016

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 42

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 42

Affiliated clinicians 732

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 732

NPI Registry JSON

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

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1225500770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 GRANT ST, US STEEL TOWER, 59TH FLOOR",
            "address_2": "C/O RENEE JOHNSON",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152192740",
            "telephone_number": "412-623-6303",
            "fax_number": "412-623-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011909",
            "telephone_number": "570-326-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC WILLIAMSPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "STOCKHAUSEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "412-578-9592"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007548350043",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "uconnect.upmc.com",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.552.100.2.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "600 Grant St",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UPMCHospitals@upmcdirect.com",
            "affiliation": "N",
            "endpointDescription": "secure direct address for this UPMC Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1100 Grampian Blvd",
            "city": "Williamsport",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177011909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Williamsport Regional Medical Center SPU- Divine Providence Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williamsport Regional Medical Center SPU- Divine Providence Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.