NPIMap

Organization Active NPI

Good Samaritan Physician Services

Doing business as WellSpan Urology - Lebanon

  • Urology Physician
  • Lebanon, PA
National Provider Identifier
1558749846
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
GOOD SAMARITAN PHYSICIAN SERVICES
Doing business as
WellSpan Urology - Lebanon
Practice address
735 Norman Dr
Suite B
Lebanon, PA 17042-7497
Phone
(717) 270-7908
Fax
(717) 272-1734
NPI assigned
May 7, 2015
Last updated
Oct 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Jody M Boger
Title
Credentialing Coordinator
Phone
(717) 270-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

735 Norman Dr
Suite B
Lebanon, PA 17042-7497

Mailing address

PO Box 300
Lebanon, PA 17042-0300
Phone (717) 270-7780

Other identifiers 1

IdentifierTypeStateIssuer
001864024MedicaidPA

Other names 1

  • WellSpan Urology - Lebanon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000854 PA Part B Supplier - Clinic/Group Practice 5496728172 Receives reassigned benefits from 153 practitioners
19 other NPIs on this enrollment
Practice locations: Ephrata, PA; York, PA; Waynesboro, PA; New Holland, PA; Lewisburg, PA; Lebanon, PA; Lancaster, PA; Chambersburg, PA…

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Physician Services10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 158

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 158

NPI Registry JSON

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1558749846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170420300",
            "telephone_number": "717-270-7780",
            "fax_number": "717-274-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 NORMAN DR",
            "address_2": "SUITE B",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-270-7908",
            "fax_number": "717-272-1734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "BOGER",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-270-7780"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001864024",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Urology - Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.