St Luke'S Physician Group Inc

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD034814L Issued in PA

Legal business name

ST LUKE'S PHYSICIAN GROUP INC

Practice address

360 W Ruddle St
Coaldale, PA 18218-1027

Phone

(570) 645-8121

Fax

(570) 645-8875

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Smita Satish Mody, MD

Title

Anesthesiologist

Phone

(570) 645-8121

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1528132107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 W RUDDLE ST",
            "city": "COALDALE",
            "state": "PA",
            "postal_code": "182181027",
            "telephone_number": "570-645-8121",
            "fax_number": "570-645-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W RUDDLE ST",
            "city": "COALDALE",
            "state": "PA",
            "postal_code": "182181027",
            "telephone_number": "570-645-8121",
            "fax_number": "570-645-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S PHYSICIAN GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "MODY",
        "authorized_official_first_name": "SMITA",
        "authorized_official_middle_name": "SATISH",
        "authorized_official_title_or_position": "ANESTHESIOLOGIST",
        "authorized_official_telephone_number": "570-645-8121",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD034814L",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD034814L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Lynn Nowacki, OTR/L
• Michael Paul Sabol, D.O.
• Dilliswar Sahoo, MD
• Jennifer M. Smell
• Joseph L Spadoni, M.D.
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc.
• The Carbon-Schuylkill Community Hospital, Inc.
• The Carbon-Schuylkill Community Hospital, Inc.

• Anesthesiology Physician in Coaldale, PA
• Providers in Coaldale, PA by specialty
• Anesthesiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.