David T Superdock, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD041940L Issued in PA

Practice address

562 W 2ND Ave
Lititz, PA 17543-1816

Phone

(717) 626-2167

Fax

(717) 626-1915

NPI assigned

Dec 15, 2005

Last updated

Sep 1, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dsuperdock1263@direct-lghealth.org

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.

• Lancaster General Medical Group

  dba Penn Medicine LGHP Behavioral Health

  • Psychiatry Physician
  • Lancaster, PA
  • NPI 1952392383
  Medicare reassignment NPD
• Lancaster General Medical Group

  • Obstetrics & Gynecology Physician
  • Lancaster, PA
  • NPI 1306724570
  NPD

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188604800000",
    "number": "1326023045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167",
            "fax_number": "717-626-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167",
            "fax_number": "717-626-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERDOCK",
        "first_name": "DAVID",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2007-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD041940L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "37716 S1QG",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "615224",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY HEALTH PLAN",
            "identifier": "P002303",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "E23590",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012090930001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5659089",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "01971402",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "578406",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aneta Strus, DPM
• Eric Thaddeus Sugarman
• John Sullivan
• Daniel Summers, M.D.
• Veronica Sundberg, OTR
• Stephanie Arlene Swann, LPC MT BC
• Wendy Sweigart-Hathaway, LPTA
• Sameera M Syed, M.D.
• T. W. Ponessa and Associates Counseling Services, Inc.
• Morgan Tappen, LMT

• Family Medicine Physician in Lititz, PA
• Providers in Lititz, 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 Sep 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.