NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

Doing business as St. Luke's Pediatric Gastroenterology

  • Pediatric Gastroenterology Physician
  • Fountain Hill, PA
National Provider Identifier
1295083426
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Doing business as
St. Luke's Pediatric Gastroenterology
Practice address
701 Ostrum St
Suite 102
Fountain Hill, PA 18015-1155
Phone
(484) 526-7575
Fax
(484) 526-7570
NPI assigned
Aug 20, 2012
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Sue Chiavaroli
Title
Manager
Phone
(484) 526-3569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0206X Primary

Addresses

Primary practice location

701 Ostrum St
Suite 102
Fountain Hill, PA 18015-1155

Mailing address

701 Ostrum St
Suite 102
Fountain Hill, PA 18015-1155
Phone (484) 526-7575

Other names 1

  • St. Luke's Pediatric Gastroenterology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1295083426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 102",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "484-526-7575",
            "fax_number": "484-526-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 102",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "484-526-7575",
            "fax_number": "484-526-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-20",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "CHIAVAROLI",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "484-526-3569"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Pediatric Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fountain Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.