NPIMap

Organization Active NPI

Wellspan Medical Group

  • Internal Medicine Physician
  • Gettysburg, PA
National Provider Identifier
1306277488
Registry record updated Sep 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSPAN MEDICAL GROUP
Practice address
423 S Washington St
Gettysburg, PA 17325-2526
Phone
(717) 339-3165
Fax
(717) 334-3140
NPI assigned
Nov 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2014

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

Authorized official

Name
Ms. Amy F Wilkinson
Title
Credentialing Supervisor
Phone
(717) 851-1401

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

423 S Washington St
Gettysburg, PA 17325-2526

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 339-3165

Other names 1

  • WellSpan Internal Medicine-Washington Street Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000815 PA Part B Supplier - Clinic/Group Practice 1951213115 Receives reassigned benefits from 3,390 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0187275Wellspan Internal Medicine, Washington Street423 South Washington St, Gettysburg, PA 17325Certificate of waiverSep 10, 2026

National Provider Directory

National Provider Directory
Tax ID family
Linda M Miller177 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1306277488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-339-3165",
            "fax_number": "717-334-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 S WASHINGTON ST",
            "city": "GETTYSBURG",
            "state": "PA",
            "postal_code": "173252526",
            "telephone_number": "717-339-3165",
            "fax_number": "717-334-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "717-851-1401",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Internal Medicine-Washington Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gettysburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.