NPIMap

Individual provider Active NPI

Sally Jo Ferguson-Avery, MD

  • Internal Medicine Physician
  • Shamokin Dam, PA
National Provider Identifier
1508805615
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD423495 Issued in PA
Practice address
3057 N Susquehanna TRL
Shamokin Dam, PA 17876-9114
Phone
(570) 743-1112
Fax
(570) 743-1114
NPI assigned
Jun 5, 2006
Last updated
Apr 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD423495 PA Primary
Pediatrics Physician 208000000X MD423495 PA

Addresses

Primary practice location

3057 N Susquehanna TRL
Shamokin Dam, PA 17876-9114

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other identifiers 1

IdentifierTypeStateIssuer
1009301640002MedicaidPA

Other names 1

  • Sally Jo Ferguson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SallyFergusonAveryMD@FPC.medentdirect.com Health Information Exchange (HIE) FAMILY PRACTICE CENTER, PC

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
I20040621001096 PA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3971588393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Mercer University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Practice Center PCGroup PAC ID 0244124212, 351 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-5889

1205 River Ave
Williamsport, PA 17701-3724

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

21 Susquehanna Valley Mall Dr
Suite a
Selinsgrove, PA 17870-9148
Phone (570) 374-7852

270 Susquehanna Valley Mall Dr
Selinsgrove, PA 17870-9115

3057 N Susquehanna Trail
PO Box 310
Shamokin Dam, PA 17876-9114
Phone (570) 743-1112

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD423495PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC CurrentSince Sep 6, 2005 Accepting new patients
Family Practice Center, PC Internal Medicine CurrentSince Sep 6, 2005 Accepting new patients

Locations

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

270 Susquehanna Valley Mall Dr
Ste 100
Selinsgrove, PA 17870
Phone (570) 743-1703

3057 N Susquehanna Trl
Shamokin Dam, PA 17876
Phone (570) 743-1112

Interoperability endpoints

  • Direct secure messaging: sallyfergusonaverymd@fpc.medentdirect.com

Organizations & group practices 2

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

Hospital & facility affiliations 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1508805615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3057 N SUSQUEHANNA TRL",
            "city": "SHAMOKIN DAM",
            "state": "PA",
            "postal_code": "178769114",
            "telephone_number": "570-743-1112",
            "fax_number": "570-743-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON-AVERY",
        "first_name": "SALLY",
        "middle_name": "JO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD423495",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD423495",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009301640002",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SallyFergusonAveryMD@FPC.medentdirect.com",
            "affiliation": "Y",
            "affiliationName": "FAMILY PRACTICE CENTER, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3057 N Susquehanna Trl",
            "city": "Shamokin Dam",
            "state": "PA",
            "country_code": "US",
            "postal_code": "178769114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "FERGUSON",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shamokin Dam, PA

Sources for this page

Verify at the official NPI Registry.