NPIMap

Organization Active NPI

Wellspan Medical Group

Doing business as WellSpan Urgent Care

  • Urgent Care Clinic/Center
  • Gettysburg, PA
National Provider Identifier
1386894392
Registry record updated Aug 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
WELLSPAN MEDICAL GROUP
Doing business as
WellSpan Urgent Care
Practice address
455 S Washington St
Ste 12
Gettysburg, PA 17325-2516
Phone
(717) 339-2875
Fax
(717) 334-3921
NPI assigned
Sep 26, 2008
Last updated
Aug 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2017

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

Authorized official

Name
Ms. Christina Moon
Title
Credentialing Supervisor
Phone
(717) 851-1404

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary
Nurse Practitioner 363L00000X NU
Acute Care Nurse Practitioner 363LA2100X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

455 S Washington St
Ste 12
Gettysburg, PA 17325-2516

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Other identifiers 2

IdentifierTypeStateIssuer
100772136MedicaidPA
F561OtherMDCAREFIRST MD BCBS

Other names 1

  • WellSpan Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000815 PA Part B Supplier - Clinic/Group Practice 1951213115 Receives reassigned benefits from 3,390 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2226743Wellspan Urgent Care - Gettysburg455 S Washington Street, Gettysburg, PA 17325Certificate of waiverJun 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503964800000",
    "number": "1386894392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S WASHINGTON ST",
            "address_2": "STE 12",
            "city": "GETTYSBURG",
            "state": "PA",
            "postal_code": "173252516",
            "telephone_number": "717-339-2875",
            "fax_number": "717-334-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-26",
        "last_updated": "2017-08-29",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "717-851-1404",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100772136",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "F561",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gettysburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2017; 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.