NPIMap

Organization Active NPI

St. Luke'S Physician Group, Inc.

  • Obstetrics & Gynecology Physician
  • Fountain Hill, PA
National Provider Identifier
1508104894
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Practice address
701 Ostrum St
Suite 501
Fountain Hill, PA 18015-1155
Phone
(484) 526-6161
Fax
(484) 526-6385
NPI assigned
Jan 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Authorized official

Name
Dean W. Evans
Title
President
Phone
(484) 526-3383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

701 Ostrum St
Suite 501
Fountain Hill, PA 18015-1155

Mailing address

701 Ostrum St
Suite 501
Fountain Hill, PA 18015-1155
Phone (484) 526-6161

Other practice location 1

701 Ostrum St
Suite 501
Fountain Hill, PA 18015-1155
Phone (610) 867-6161

Other identifiers 1

IdentifierTypeStateIssuer
100730753MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Upper Bucks Emergency M165 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5445 Lanark Rd
Ste 103
Center Valley, PA 18034
Phone (484) 526-5580

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1508104894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 501",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "484-526-6161",
            "fax_number": "484-526-6385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 501",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "484-526-6161",
            "fax_number": "484-526-6385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Ostrum St",
            "address_2": "Suite 501",
            "address_purpose": "LOCATION",
            "city": "Fountain Hill",
            "state": "PA",
            "postal_code": "180151155",
            "country_code": "US",
            "telephone_number": "610-867-6161",
            "fax_number": "610-868-9931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-22",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-3383"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100730753",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; 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.