NPIMap

Organization Active NPI

Susquehanna Physician Services

Doing business as Susquehanna Health Medical Group

  • Otolaryngology Physician
  • Williamsport, PA
National Provider Identifier
1346263266
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Doing business as
Susquehanna Health Medical Group
Practice address
1705 Warren Ave
Suite 204-205
Williamsport, PA 17701-2647
Phone
(570) 320-7474
Fax
(570) 320-7479
NPI assigned
Jul 25, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Ms. Melissa Davis
Title
VP/Coo
Phone
(570) 320-7696

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X
Audiologist-Hearing Aid FitterGroup: 193200000X MULTI-SPECIALTY GROUP 237600000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1705 Warren Ave
Suite 204-205
Williamsport, PA 17701-2647

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Other practice location 1

6850 Lows Rd Ste 320
Bloomsburg, PA 17815-8708
Phone (570) 387-4368

Other identifiers 3

IdentifierTypeStateIssuer
0017300760201MedicaidPA
0017300760202MedicaidPA
501737OtherPAHIGHMARK BLUE SHIELD

Other names 1

  • Susquehanna Health Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309000205 PA Part B Supplier - Clinic/Group Practice 2264336460 Receives reassigned benefits from 20 practitioners
Practice locations: Williamsport, PA; Muncy, PA; Lock Haven, PA; Lewisburg, PA; Wellsboro, PA

National Provider Directory

National Provider Directory

Locations

1705 Warren Ave
#204205
Williamsport, PA 17701
Phone (570) 320-7474

1705 Warren Ave
Ste 204205
Williamsport, PA 17701
Phone (570) 320-7474

1705 Warren Ave
Ste U4
Williamsport, PA 17701
Phone (570) 320-7474

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1346263266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 WARREN AVE",
            "address_2": "SUITE 204-205",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012647",
            "telephone_number": "570-320-7474",
            "fax_number": "570-320-7479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6850 Lows Rd Ste 320",
            "address_purpose": "LOCATION",
            "city": "Bloomsburg",
            "state": "PA",
            "postal_code": "178158708",
            "country_code": "US",
            "telephone_number": "570-387-4368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "570-320-7696",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760201",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760202",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "501737",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.