Ellen R Superdock, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP020508 Issued in PA

Practice address

920 Church St
Lebanon, PA 17046-4656

Phone

(717) 272-2700

NPI assigned

Sep 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ellen.superdock.1@14261.direct.athenahealth.com

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.

• Union Community Care

  • Federally Qualified Health Center (FQHC)
  • Lancaster, PA
  • NPI 1134458789
  Medicare reassignment NPD
• Union Community Care

  • Federally Qualified Health Center (FQHC)
  • Lancaster, PA
  • NPI 1417812710
  NPD
• Union Community Care

  • Federally Qualified Health Center (FQHC)
  • New Holland, PA
  • NPI 1942437991
  NPD
• Union Community Care

  • Federally Qualified Health Center (FQHC)
  • Lancaster, PA
  • NPI 1801853346
  NPD (past)

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1497306336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 N WATER ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176033374",
            "telephone_number": "717-735-6808",
            "fax_number": "717-325-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 CHURCH ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170464656",
            "telephone_number": "717-272-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 S Kinzer Ave Ste 6",
            "address_purpose": "LOCATION",
            "city": "New Holland",
            "state": "PA",
            "postal_code": "175578706",
            "country_code": "US",
            "telephone_number": "717-351-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPERDOCK",
        "first_name": "ELLEN",
        "middle_name": "R",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP020508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Sudbury, PT
• James Suleski
• Kara Summers
• Sundance Rehabilitation Agency LLC
• Andrew Murphy Superdock, D.M.D.
• Surgery Center of Lebanon, LP
• Emily Alexandra Swanger, CCC-SLP
• Jennifer Swanson
• Jerome Swierczynski, CRNA
• Charles Marvin Swingholm, R.N.

• Family Nurse Practitioner in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.