NPIMap

Organization Active NPI

Northern Lancaster County Medical Group

Doing business as Wellspan Family Medicine-Lake Street

  • Family Medicine Physician
  • Ephrata, PA
National Provider Identifier
1346344561
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Doing business as
Wellspan Family Medicine-Lake Street
Practice address
136 A & B Lake Street
Ephrata, PA 17522-2415
Phone
(717) 721-7718
Fax
(717) 721-7726
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

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

Authorized official

Name
Charles David Noll, DO
Title
Vice President
Phone
(717) 859-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

136 A & B Lake Street
Ephrata, PA 17522-2415

Mailing address

136 Lake St
Ephrata, PA 17522-2415
Phone (717) 721-7718

Other identifiers 3

IdentifierTypeStateIssuer
DD6938OtherPARAILROAD MEDICARE
1013977730008MedicaidPA
1746343OtherPABLUE SHIELD

Other names 1

  • Wellspan Family Medicine-Lake Street Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1346344561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 LAKE ST",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175222415",
            "telephone_number": "717-721-7718",
            "fax_number": "717-721-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 A & B LAKE STREET",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175222415",
            "telephone_number": "717-721-7718",
            "fax_number": "717-721-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LANCASTER COUNTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "NOLL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-859-5161",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD6938",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013977730008",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1746343",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspan Family Medicine-Lake Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ephrata, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.