NPIMap

Individual provider Active NPI

Marissa Lara Ambron, D.O.

  • Internal Medicine Physician
  • Williamsport, PA
National Provider Identifier
1518113570
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS014928 Issued in PA
Practice address
700 High Street
Williamsport, PA 17701-3198
Phone
(570) 321-2850
Fax
(570) 321-2851
NPI assigned
Aug 11, 2008
Last updated
Jan 11, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0012720 PA
Internal Medicine Physician 207R00000X OS014928 PA Primary
Hospitalist Physician 208M00000X OS014928 PA

Addresses

Primary practice location

700 High Street
Williamsport, PA 17701-3198

Mailing address

1201 Grampian Blvd
Suite 1K
Williamsport, PA 17701-1900

Other names 1

  • Dr. Marissa Lara Weaknecht Former name

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
I20110714000328 PA Practitioner - Internal Medicine 8820266067 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

1021 Park Ave
Quakertown, PA 18951-0130
Phone (215) 538-4500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0012720PAMDInternal Medicine Physician
OS014928PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Physician Group Inc Internal Medicine CurrentSince Apr 1, 2012 Accepting new patients
Gslpg, Inc CurrentSince Feb 12, 2024 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Apr 1, 2012 Accepting new patients
St. Luke's Physician Group, Inc. Past Accepting new patients
St Lukes Hospital Past Accepting new patients
St Luke's Hospital Past Accepting new patients
St. Luke's Hospital Past Accepting new patients

Locations

1736 Hamilton St
Allentown, PA 18104
Phone (610) 770-8300

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

100 Paramount Blvd
Orwigsburg, PA 17961
Phone (272) 639-1000

Interoperability endpoints

  • Direct secure messaging: marissa.ambron@slpg.direct-sluhn.org

Organizations & group practices 8

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 9

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": "1218412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1518113570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "address_2": "SUITE 1K",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HIGH STREET",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013198",
            "telephone_number": "570-321-2850",
            "fax_number": "570-321-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBRON",
        "first_name": "MARISSA",
        "middle_name": "LARA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-11",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "0012720",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS014928",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "OS014928",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "WEAKNECHT",
            "middle_name": "LARA",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.