Penn State Health Medical Group, LLC
Organization Active NPI Pediatrics Physician · West Reading, PA
NPI 1609347152 · NPPES record last updated Feb 3, 2026
Key facts
- NPI
- 1609347152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- PENN STATE HEALTH MEDICAL GROUP, LLC
- Practice address
- 655 Walnut St
West Reading, PA 19611-1242 - Phone
- (610) 372-9222
- Fax
- (610) 372-0232
- NPI assigned
- Dec 10, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- PENN STATE HEALTH
Authorized official
- Name
- Tracy L Moyer-Swinko
- Title
- VP, Chief Financial Officer
- Phone
- (717) 531-8477
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 16
Practitioners 70
-
Javed Ahmad, MD
-
Shane Appel, M.D.
-
Kimberlee Bardo, CRNA
-
Kristen N Berfield, CRNP
-
Sally Ann Blaine, MD
-
Brian P Bloom, MD
-
Elisabeth R Cate-Freeman, CRNP
-
Xueying Chen, M.D.
-
Rekha A Cherian, MD
-
Larry Cicero, CRNA
-
Emylio Cutiva, ACNP-AG
-
Niladri Das, MD
-
Kennedy M Dickhoff, CRNP
-
Margarita Fisher, CRNP
-
Jacob Burns Fronko, PA-C
-
Casi Goble, CRNP
-
Elaine Y Greene, CNM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170907002279 | PA | Part B Supplier - Clinic/Group Practice | 8729351077 |
Receives reassigned benefits from 970 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Penn State Health
Locations
51 Business Campus Way
Ste 200
Duncannon, PA 17020
Phone (717) 834-3108
2160 State Rd
Ste 1840
Lancaster, PA 17601
Phone (223) 287-8170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
655 Walnut St
West Reading, PA 19611-1242
Mailing address
PO Box 825972
Philadelphia, PA 19182-5972
Phone (717) 531-4859
Other providers in West Reading, PA
- Robert C Pease
- Bailey Arias Pechner
- Tiany Santana Peguero
- Dennis John Pellecchia
- Vincent A Pellegrini
- John Michael Penta
- Sean B Peppard
- Karen A Pescatore
- Erin Marie Pfeffer
- Gordon Phillips
All providers in West Reading, PA · Pediatrics Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.