Penn Medicine LGHP Geriatrics

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PENN MEDICINE LGHP GERIATRICS

Practice address

212 Willow Lakes Dr.
Suite 101
Willow Street, PA 17584

Phone

(717) 464-0286

NPI assigned

Aug 28, 2015

Last updated

Sep 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Brown

Title

Provider Coordinator

Phone

(717) 544-1921

Specialties & licenses 2

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14261/brand/6/csg/1/fhir/r4

Practitioners 2

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.

• Thomas Dokubo Braide, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Willow Street, PA
  • NPI 1598969404
  NPD
• Kelly Allyse Stauffer, CRNP

  • Geriatric Medicine (Family Medicine) Physician
  • Lancaster, PA
  • NPI 1689488702
  NPD (past)

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

{
    "created_epoch": "1440720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1306213020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 WILLOW VALLEY LAKES DR STE 101",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849668",
            "telephone_number": "717-464-0286",
            "fax_number": "717-945-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 WILLOW LAKES DR.",
            "address_2": "SUITE 101",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "17584",
            "telephone_number": "717-464-0286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN MEDICINE LGHP GERIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-28",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PROVIDER COORDINATOR",
        "authorized_official_telephone_number": "717-544-1921"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Paige M Pachuilo, MS, OTR/L
• Gregory Ryan Patrick
• Jennifer Perrotti, MSW/LSW
• Personal Angels Inc.
• Personal Angels Inc. (Home Helpers)
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• Kara Noelle Phongxaysanith, CCC-SLP

• Family Nurse Practitioner in Willow Street, PA
• Providers in Willow Street, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.