St. Luke'S Physician Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ST. LUKE'S PHYSICIAN GROUP, INC.

Doing business as

St. Luke's Brodheadsville Family Practice

Practice address

111 Route 715 Ste 101
Brodheadsville, PA 18322-7101

Phone

(272) 212-0435

Fax

(272) 212-0437

NPI assigned

Sep 6, 2006

Organization subpart

No

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

Authorized official

Name

Dean W Evans

Title

President

Phone

(484) 526-4911

Specialties & licenses 1

Addresses

Other names 1

• St. Luke's Brodheadsville Family Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Caitlin Rose Bayer, PA-C

  • Physician Assistant
  • Brodheadsville, PA
  • NPI 1518651090
  NPD
• Kimberly Derezil, M.D.

  • Family Medicine Physician
  • Allentown, PA
  • NPI 1841561198
  NPD
• Jose G Guzman, MD

  • Family Medicine Physician
  • Brodheadsvlle, PA
  • NPI 1033472857
  NPD
• Traci Stahl, CRNP

  • Family Nurse Practitioner
  • Rockingham, VA
  • NPI 1669651717
  NPD

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516147200000",
    "number": "1275636185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000",
            "telephone_number": "484-526-6048",
            "fax_number": "484-526-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ROUTE 715 STE 101",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227101",
            "telephone_number": "272-212-0435",
            "fax_number": "272-212-0437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2018-01-17",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-4911"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Brodheadsville Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Luke's Brodheadsville Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Smith, MS, OTR/L
• Samantha J Snyder
• Katherine Sparrow, DC
• Casey Sprung, PT, DPT
• St. Luke'S Hospital Monroe Campus
• Allison Marie Stafford, D.C.
• Holly Stone, M.D.
• Virginia S Sutter, LSW
• Anthony Tavella, PA-C
• Erika Jo Trout, LAT, ATC

• Family Medicine Physician in Brodheadsville, PA
• Providers in Brodheadsville, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; 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.