NPIMap

Individual provider Active NPI

Edward Jospeh Tadajweski, M.D.

  • Cardiovascular Disease Physician
  • Lebanon, PA
National Provider Identifier
1235280363
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD 422470 Issued in PA
Practice address
775 Norman Dr
Lebanon, PA 17042-7497
Phone
(717) 274-5500
Fax
(717) 202-0130
NPI assigned
Jan 16, 2007
Last updated
Nov 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD 422470 PA Primary

Addresses

Primary practice location

775 Norman Dr
Lebanon, PA 17042-7497

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

1400 S Forge Rd
Palmyra, PA 17078-9519
Phone (717) 274-5500

Other practice location 2

140 N Pointe Blvd
Lancaster, PA 17601-4132
Phone (717) 291-0700

Other practice location 3

169 Martin Ave
Ephrata, PA 17522-1734
Phone (717) 738-6423

Other identifiers 2

IdentifierTypeStateIssuer
1946433OtherPAHIGHMARK BLUE SHIELD
PO1680534OtherPARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070419000343 PA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8527163583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
University of Pittsburgh School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

775 Norman Dr
Wellspan Cardiology
Lebanon, PA 17042-7497
Phone (717) 274-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 422470PAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Jun 30, 2016 Accepting new patients
Ephrata Community Hospital CurrentSince Feb 5, 2021 Accepting new patients
Ephrata Community Hospital Cardiovascular Disease CurrentSince Feb 5, 2021 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Chet Phitayakorn, MD PC Past Accepting new patients
John C Phillips MD LLC Cardiovascular Disease Past Accepting new patients
Jalit Tuchinda M.D., PC Past Accepting new patients

Locations

169 Martin Ave
Ephrata, PA 17522
Phone (717) 733-0311

140 N Pointe Blvd
Lancaster, PA 17601
Phone (717) 291-0700

252 S 4th St
Lebanon, PA 17042
Phone (717) 270-7500

775 Norman Dr
Lebanon, PA 17042
Phone (717) 274-5500

1400 S Forge Rd
Palmyra, PA 17078
Phone (717) 274-5500

1400 S Forge Rd
Ste 4
Palmyra, PA 17078
Phone (717) 274-5500

1600 S George St
York, PA 17403
Phone (717) 848-3615

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

Interoperability endpoints

  • Direct secure messaging: etadajweski12766@wellspan.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellspan Ephrata Community HospitalEphrata, PA, CCN 390225 Hospital Corporate Director Jan 1, 2021
Wellspan Ephrata Community HospitalEphrata, PA, CCN 39T225 Hospital Corporate Director Jan 1, 2021
Wellspan Ephrata Community Hospital - Behavioral Health UnitEphrata, PA, CCN 39S225 Hospital Corporate Director Jan 1, 2021
Wellspan Good Samaritan HospitalLebanon, PA, CCN 390066 Hospital Corporate Director Jan 1, 2021
Wellspan Good Samaritan HospitalLebanon, PA, CCN 39T066 Hospital Corporate Director Jan 1, 2021
PhilhavenLebanon, PA, CCN 394020 Hospital Corporate Director Jan 1, 2021

Owned or controlled facilities with NPI records 15

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 15

Organizations & group practices 7

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

Hospital & facility affiliations 8

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1235280363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-274-5500",
            "fax_number": "717-202-0130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Forge Rd",
            "address_purpose": "LOCATION",
            "city": "Palmyra",
            "state": "PA",
            "postal_code": "170789519",
            "country_code": "US",
            "telephone_number": "717-274-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140 N Pointe Blvd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176014132",
            "country_code": "US",
            "telephone_number": "717-291-0700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "169 Martin Ave",
            "address_purpose": "LOCATION",
            "city": "Ephrata",
            "state": "PA",
            "postal_code": "175221734",
            "country_code": "US",
            "telephone_number": "717-738-6423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TADAJWESKI",
        "first_name": "EDWARD",
        "middle_name": "JOSPEH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD 422470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1946433",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "PO1680534",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.