NPIMap

Organization Active NPI

Good Samaritan Physician Services

Doing business as WellSpan Cardiothoracic Surgery - Lebanon

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lebanon, PA
National Provider Identifier
1407096951
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
GOOD SAMARITAN PHYSICIAN SERVICES
Doing business as
WellSpan Cardiothoracic Surgery - Lebanon
Practice address
4TH & Walnut Streets
2ND Floor
Lebanon, PA 17042-6123
Phone
(717) 270-3751
Fax
(717) 270-3754
NPI assigned
Feb 24, 2009
Last updated
Oct 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Jody M Boger
Title
Credentialing Coordinator
Phone
(717) 270-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

4TH & Walnut Streets
2ND Floor
Lebanon, PA 17042-6123

Mailing address

PO Box 300
Lebanon, PA 17042-0300
Phone (717) 270-7780

Other identifiers 1

IdentifierTypeStateIssuer
001864024MedicaidPA

Other names 1

  • WellSpan Cardiothoracic Surgery - Lebanon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000854 PA Part B Supplier - Clinic/Group Practice 5496728172 Receives reassigned benefits from 153 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ephrata, PA; York, PA; Waynesboro, PA; New Holland, PA; Lewisburg, PA; Lebanon, PA; Lancaster, PA; Chambersburg, PA…

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1407096951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170420300",
            "telephone_number": "717-270-7780",
            "fax_number": "717-274-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4TH & WALNUT STREETS",
            "address_2": "2ND FLOOR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426123",
            "telephone_number": "717-270-3751",
            "fax_number": "717-270-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-24",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "BOGER",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-270-7780"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001864024",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Cardiothoracic Surgery - Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.