NPIMap

Organization Active NPI

St. Luke's Physician Group

  • Pediatrics Physician
  • Palmerton, PA
National Provider Identifier
1386069474
Registry record updated Feb 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD065630L Issued in PA
Legal business name
ST. LUKE'S PHYSICIAN GROUP
Practice address
217 Franklin Ave Ste 5
Palmerton, PA 18071-1521
Phone
(484) 426-2001
Fax
(484) 426-2004
NPI assigned
Feb 26, 2014
Last updated
Feb 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2018

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

Authorized official

Name
Mr. Dean W Evans
Title
President
Phone
(484) 526-4991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X MD065630L PA Primary

Addresses

Primary practice location

217 Franklin Ave Ste 5
Palmerton, PA 18071-1521

Mailing address

217 Franklin Ave Ste 5
Palmerton, PA 18071-1521
Phone (484) 426-2001

Other practice location 1

217 Franklin Ave
Palmerton, PA 18071-1521
Phone (610) 826-1166

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Orthopaedic Surgical GR165 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

Locations

217 Franklin Ave
Ste 5
Palmerton, PA 18071
Phone (484) 426-2001

NPI Registry JSON

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518048000000",
    "number": "1386069474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 FRANKLIN AVE STE 5",
            "city": "PALMERTON",
            "state": "PA",
            "postal_code": "180711521",
            "telephone_number": "484-426-2001",
            "fax_number": "484-426-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 FRANKLIN AVE STE 5",
            "city": "PALMERTON",
            "state": "PA",
            "postal_code": "180711521",
            "telephone_number": "484-426-2001",
            "fax_number": "484-426-2004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Palmerton",
            "state": "PA",
            "postal_code": "180711521",
            "country_code": "US",
            "telephone_number": "610-826-1166",
            "fax_number": "610-824-5121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2018-02-08",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-4991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD065630L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmerton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.