NPIMap

Individual provider Active NPI

Etieno Usen Umobong, M.D.

  • Pulmonary Disease Physician
  • Mechanicsburg, PA
National Provider Identifier
1467748657
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD471227 Issued in PA
Practice address
2005 Technology Pkwy Ste 300
Mechanicsburg, PA 17050-9423
Phone
(717) 988-5864
NPI assigned
Jun 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD471227 PA
Surgery Physician 208600000X MT200560 PA
Student in an Organized Health Care Education/Training Program 390200000X TO BE ISSUED NY
Pulmonary Disease Physician 207RP1001X MD471227 PA Primary

Addresses

Primary practice location

2005 Technology Pkwy Ste 300
Mechanicsburg, PA 17050-9423

Mailing address

2005 Technology Pkwy Ste 300
Mechanicsburg, PA 17050-9423
Phone (717) 988-5864

Other practice location 1

1995 Technology Pkwy
Mechanicsburg, PA 17050-8522
Phone (717) 231-8772

Other practice location 2

300 Community Dr
4Dsu
Manhasset, NY 11030-3816
Phone (516) 562-4764

Other practice location 3

4310 Londonderry Rd Ste 106
Harrisburg, PA 17109
Phone (717) 988-8210

Other identifiers 1

IdentifierTypeStateIssuer
103787651MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eumobong175735@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200723000256 PA Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 9436493061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Health Medical ServicesGroup PAC ID 7618960493, 1,025 clinicians

Practice addresses (Care Compare)

111 S Front St
Harrisburg, PA 17101-2010

1995 Technology Pkwy
Mechanicsburg, PA 17050-8522
Phone (717) 231-8772

2005 Technology Pkwy
Mechanicsburg, PA 17050-9413

2501 N 3Rd St
Kline Health Center Foot and Ankle
Harrisburg, PA 17110-1904
Phone (717) 782-2100

2501 N 3Rd St 2ND FL Kline HC
Reach Program
Harrisburg, PA 17110-1904
Phone (717) 782-2363

2501 N 3Rd St FL
2 Kline Health Center
Harrisburg, PA 17110-1904
Phone (717) 782-2100

2501 N 3Rd Street 2ND Floor
Pinnaclehealth Psychological Associates
Harrisburg, PA 17110-1904
Phone (717) 782-2143

361 Alexander Spring Rd
Carlisle, PA 17015-6940
Phone (717) 231-8508

409 S 2ND St
Harrisburg, PA 17104-1612

4300 Londonderry Rd
Harrisburg, PA 17109-5317

4310 Londonderry Rd
Harrisburg, PA 17109-5333

Hospital & facility affiliations

  • Upmc Pinnacle Hospitals Hospital, Harrisburg, PA, CCN 390067
  • Upmc Carlisle Hospital, Carlisle, PA, CCN 390058
  • Upmc Memorial Hospital, York, PA, CCN 390101

Merit-based Incentive Payment System (MIPS)

Final score
86.08 of 100Reported as group
Quality
76.48
Promoting interoperability
100
Improvement activities
40
Cost
77.12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD471227PAMDPulmonary Disease Physician
MT200560PAMDSurgery Physician
TO BE ISSUEDNYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services Internal Medicine Current Accepting new patients
Pinnacle Health Medical Services CurrentSince Aug 3, 2020 Accepting new patients
Pinnacle Health Medical Services CurrentSince Aug 3, 2020 Accepting new patients
Pinnacle Health Medical Services Past Accepting new patients

Locations

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

4310 Londonderry Rd
Ste 106
Harrisburg, PA 17109
Phone (717) 724-6780

2005 Technology Pkwy
Ste 300
Mechanicsburg, PA 17050
Phone (717) 782-4785

1995 Technology Pkwy
Mechanicsburg, PA 17050
Phone (717) 791-2600

Interoperability endpoints

  • Direct secure messaging: eumobong306194@upmc.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1467748657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 TECHNOLOGY PKWY STE 300",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170509423",
            "telephone_number": "717-988-5864",
            "fax_number": "717-221-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 TECHNOLOGY PKWY STE 300",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170509423",
            "telephone_number": "717-988-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1995 Technology Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mechanicsburg",
            "state": "PA",
            "postal_code": "170508522",
            "country_code": "US",
            "telephone_number": "717-231-8772",
            "fax_number": "717-231-8435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Community Dr",
            "address_2": "4DSU",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303816",
            "country_code": "US",
            "telephone_number": "516-562-4764",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4310 Londonderry Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "17109",
            "country_code": "US",
            "telephone_number": "717-988-8210",
            "fax_number": "717-221-5260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UMOBONG",
        "first_name": "ETIENO",
        "middle_name": "USEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-26",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD471227",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT200560",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "TO BE ISSUED",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "MD471227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103787651",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eumobong175735@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "1995 Technology Pkwy",
            "city": "Mechanicsburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170508522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mechanicsburg, PA

Sources for this page

Verify at the official NPI Registry.