NPIMap

Organization Active NPI

The Good Samaritan Hospital of Lebanon, Pennsylvania

Doing business as WellSpan Good Samaritan Hospital

  • General Acute Care Hospital
  • Lebanon, PA
National Provider Identifier
1407928500
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
072401 Issued in PA
Legal business name
THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Doing business as
WellSpan Good Samaritan Hospital
Practice address
252 S 4TH St
Lebanon, PA 17042-6123
Phone
(717) 270-7500
NPI assigned
Nov 14, 2006
Last updated
Apr 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Tina Citro
Title
VP & President
Phone
(717) 738-6407

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU
Radiology Clinic/Center 261QR0200X NU
Radiation Oncology Clinic/Center 261QX0203X NU
General Acute Care Hospital 282N00000X 072401 PA Primary
Emergency Medicine Physician 207P00000X NU
Clinical Pathology Physician 207ZC0006X NU

Addresses

Primary practice location

252 S 4TH St
Lebanon, PA 17042-6123

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

750 Norman Dr
Lebanon, PA 17042-7495
Phone (717) 270-8960

Other practice location 2

950 Isabel Drive
WellSpan Rehabilitation
Lebanon, PA 17042-7482
Phone (717) 270-8841

Other practice location 3

805 Helen Dr
Lebanon, PA 17042-7493
Phone (717) 273-9345

Other practice location 4

1400 S Forge Rd
Palmyra, PA 17078-9519
Phone (717) 832-0960

Other practice location 5

781 Norman Dr
Lebanon, PA 17042-7497
Phone (717) 270-1252

Other practice location 6

844 Tuck Street
Sechler Family Cancer Center
Lebanon, PA 17042-7477
Phone (717) 270-2238

Other practice location 7

297 W Lincoln Ave
Myerstown, PA 17067-2324
Phone (717) 866-9452

Other practice location 8

11 E Lincoln Ave
Myerstown, PA 17067-1108
Phone (717) 866-2700

Other practice location 9

206 Hathaway Park
WellSpan Good Samaritan Hospital Sleep Center
Lebanon, PA 17042-6162
Phone (717) 270-2349

Other practice location 10

30 North 4th Street
WellSpan Dixon Foundation Health Center
Lebanon, PA 17046-5606
Phone (717) 270-7536

Other practice location 11

840 Tuck Street
WellSpan Wound Healing
Lebanon, PA 17042-7477
Phone (717) 675-2545

Other identifiers 14

IdentifierTypeStateIssuer
1007732780004MedicaidPA
1007732780056MedicaidPA
1007732780061MedicaidPA
1007732780067MedicaidPA
1007732780068MedicaidPA
1007732780060MedicaidPA
1007732780063MedicaidPA
1007732780069MedicaidPA
1007732780055MedicaidPA
1007732780058MedicaidPA
1007732780062MedicaidPA
1007732780066MedicaidPA
1007732780059MedicaidPA
1007732780065MedicaidPA

Other names 2

  • WellSpan Good Samaritan Hospital Doing business as
  • WellSpan Good Samaritan Hospital Acute Care Hospital Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080108000258 PA Part A Provider - Hospital 5597751206 2 other NPIs on this enrollment
Practice locations: Palmyra, PA; Myerstown, PA; Lebanon, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407928500. Details of each certification follow.

Hospital certification: CCN 390066

Legal name
THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Doing business as
WELLSPAN GOOD SAMARITAN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 2, 2023
Beds
163 (145 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 23, 1891 in PA
Enrollment address
252 S 4TH St
Lebanon, PA 17042-6123
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wellspan Good Samaritan HospitalCCN 390066 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Neurology Hyman S Capla4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

206 Hathaway Park
Slp Ctr
Lebanon, PA 17042
Phone (717) 270-2349

950 Isabel Dr
Lebanon, PA 17042
Phone (717) 270-8841

297 W Lincoln Ave
Myerstown, PA 17067
Phone (717) 866-9452

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Buczkowski Individual Corporate OfficerSenior VP and Cfo Nov 30, 2020
W-2 Managing EmployeeSenior VP and Cfo Nov 30, 2020
Roxanna L Gapstur Individual OtherPresident, Wellspan Health Jan 2, 2019
Robert Hoffman Individual Corporate Officer Jul 30, 2020
Corporate Director Nov 1, 2016
Robert J Funk Individual Corporate Director Nov 1, 2016
Stephen a Lindsey Individual Corporate Director Jan 1, 2021
Christopher L Grant Individual Corporate Director Jan 1, 2021
Tina M Citro Individual Corporate OfficerVP and President WS GSH Mar 23, 2025
Corporate DirectorVP and President WS GSH Mar 23, 2025
W-2 Managing EmployeeVP and President WS GSH Mar 23, 2025
Roger Zimmerman Individual Corporate Director Jan 1, 2021
Carrie Wilson Individual Corporate OfficerVice Chair Jan 1, 2021
Moniqua Acosta Individual Corporate OfficerChair Jan 1, 2021
Corporate Director Jan 1, 2021
Michael B Seim Individual Corporate DirectorEx-Officio Jan 1, 2021
Kimberly Shaun Kreider Umble Individual Corporate Director Jan 1, 2021
Wellspan Health Organization, York, PA Non-profit Operational/Managerial Control Jul 1, 2015
Other Jul 1, 2015
Edward Joseph Tadajweski Individual Corporate Director Jan 1, 2021
James Stuccio Individual Corporate OfficerEx-Officio (Voting) Jan 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 20

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 20

Practitioners & affiliated clinicians

Practitioners 53

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 53

Affiliated clinicians 679

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 679

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1407928500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
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            "telephone_number": "717-270-7500"
        }
    ],
    "practiceLocations": [
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            "postal_code": "170427495",
            "country_code": "US",
            "telephone_number": "717-270-8960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 Isabel Drive",
            "address_2": "WellSpan Rehabilitation",
            "address_purpose": "LOCATION",
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            "state": "PA",
            "postal_code": "170427482",
            "country_code": "US",
            "telephone_number": "717-270-8841",
            "country_name": "United States",
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        },
        {
            "address_1": "805 Helen Dr",
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            "postal_code": "170427493",
            "country_code": "US",
            "telephone_number": "717-273-9345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 S Forge Rd",
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            "postal_code": "170789519",
            "country_code": "US",
            "telephone_number": "717-832-0960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "781 Norman Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427497",
            "country_code": "US",
            "telephone_number": "717-270-1252",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "844 Tuck Street",
            "address_2": "Sechler Family Cancer Center",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427477",
            "country_code": "US",
            "telephone_number": "717-270-2238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "297 W Lincoln Ave",
            "address_purpose": "LOCATION",
            "city": "Myerstown",
            "state": "PA",
            "postal_code": "170672324",
            "country_code": "US",
            "telephone_number": "717-866-9452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11 E Lincoln Ave",
            "address_purpose": "LOCATION",
            "city": "Myerstown",
            "state": "PA",
            "postal_code": "170671108",
            "country_code": "US",
            "telephone_number": "717-866-2700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "206 Hathaway Park",
            "address_2": "WellSpan Good Samaritan Hospital Sleep Center",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426162",
            "country_code": "US",
            "telephone_number": "717-270-2349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 North 4th Street",
            "address_2": "WellSpan Dixon Foundation Health Center",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170465606",
            "country_code": "US",
            "telephone_number": "717-270-7536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "840 Tuck Street",
            "address_2": "WellSpan Wound Healing",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427477",
            "country_code": "US",
            "telephone_number": "717-675-2545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "CITRO",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "VP & PRESIDENT",
        "authorized_official_telephone_number": "717-738-6407"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
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            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "072401",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780004",
            "state": "PA"
        },
        {
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            "desc": "MEDICAID",
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            "identifier": "1007732780056",
            "state": "PA"
        },
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            "state": "PA"
        },
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            "desc": "MEDICAID",
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            "state": "PA"
        },
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            "desc": "MEDICAID",
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            "identifier": "1007732780068",
            "state": "PA"
        },
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            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780060",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780063",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780069",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780055",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780058",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780062",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780066",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780059",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780065",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WellSpan Good Samaritan Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellSpan Good Samaritan Hospital Acute Care Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.