NPIMap

Individual provider Active NPI

Mandy Stull, DO

  • Internal Medicine Physician
  • Ephrata, PA
National Provider Identifier
1235420308
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS017005 Issued in PA
Practice address
169 Martin Ave
Ephrata, PA 17522-1724
Phone
(717) 721-4740
NPI assigned
Apr 25, 2011
Last updated
Dec 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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 OS017005 PA Primary

Addresses

Primary practice location

169 Martin Ave
Ephrata, PA 17522-1724

Mailing address

156 E Mohler Church Rd
Ephrata, PA 17522-9226
Phone (717) 721-4740

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
I20140902000053 PA Practitioner - Internal Medicine 2163640368 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tower Health Medical GroupGroup PAC ID 7618889213, 578 clinicians
Lancaster General HospitalGroup PAC ID 1254240039, 520 clinicians

Practice addresses (Care Compare)

2610 Keiser Blvd
Wyomissing, PA 19610-3333
Phone (484) 750-3950

301 S 7TH Ave
Radiology Tower Health Medical Group
West Reading, PA 19611-1442
Phone (484) 628-8112

420 S 5TH Ave
West Reading, PA 19611-2143

555 N Duke St
Penn Medicine Lancaster General Health Phys
Lancaster, PA 17602-2250
Phone (267) 857-7751

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Reading Health Physician Network CurrentSince Mar 12, 2018 Accepting new patients
Lancaster General Hospital CurrentSince Sep 12, 2022 Accepting new patients
Tower Health Medical Group Internal Medicine Current Accepting new patients
Lancaster General Hospital Internal Medicine CurrentSince Sep 12, 2022 Accepting new patients
Tower Health Medical Group CurrentSince Mar 12, 2018 Accepting new patients
Lancaster General Medical Group Past Accepting new patients

Locations

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

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Interoperability endpoints

  • Direct secure messaging: mstull261907@direct-lghealth.org

Organizations & group practices 6

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 9

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": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1235420308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 E MOHLER CHURCH RD",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175229226",
            "telephone_number": "717-721-4740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 MARTIN AVE",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221724",
            "telephone_number": "717-721-4740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STULL",
        "first_name": "MANDY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-25",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS017005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ephrata, PA

Sources for this page

Verify at the official NPI Registry.