St Luke'S Physician Group, Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ST LUKE'S PHYSICIAN GROUP, INC

Practice address

208 Lifeline Rd Ste 202
Stroudsburg, PA 18360-6473

Phone

(484) 526-4000

NPI assigned

May 26, 2023

Organization subpart

No

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

Addresses

Other names 1

• St. Luke's Internal Medicine Lifeline Road Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• Kelsey Clauser, CRNP

  • Nurse Practitioner
  • Orwigsburg, PA
  • NPI 1790514800
  NPD
• Matthew Dorcus, DO

  • Family Medicine Physician
  • Bethlehem, PA
  • NPI 1376160077
  NPD

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

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1326730342",
    "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": "484-526-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LIFELINE RD STE 202",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183606473",
            "telephone_number": "484-526-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S PHYSICIAN GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-26",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "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": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Internal Medicine Lifeline Road",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Luke's Internal Medicine Lifeline Road",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heidi Marie Sonnet
• Virginia Sosnowski, RN
• Jennifer Ann Sparks
• Richard Lee Spinner, DPM
• Matthew E Sprong, PHD, LCPC, CRC, CADC
• St. Luke'S Homestar Services, LLC
• St. Luke'S Hospital Monroe Campus
• St. Luke'S Hospital Monroe Campus
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc

• Internal Medicine Physician in Stroudsburg, PA
• Providers in Stroudsburg, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.