NPIMap

Organization Active NPI

Susquehanna Physician Services

  • Neurology Physician
  • Williamsport, PA
National Provider Identifier
1609808716
Registry record updated Feb 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Practice address
700 High Street
Williamsport, PA 17701-3198
Phone
(570) 321-2820
Fax
(570) 321-2821
NPI assigned
Jul 7, 2006
Last updated
Feb 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2012

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

Authorized official

Name
Mr. Charles Santangelo
Title
Executive VP/Cfo
Phone
(570) 321-3171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X PA Primary

Addresses

Primary practice location

700 High Street
Williamsport, PA 17701-3198

Mailing address

PO Box 3127
1201 Grampian Blvd
Williamsport, PA 17701-0127

Other identifiers 3

IdentifierTypeStateIssuer
0017300760176MedicaidPA
1603595OtherPAHIGHMARK BLUE SHIELD
50054352OtherPACAPITAL BLUECROSS

Other names 1

  • SPS-Neurology Other name

National Provider Directory

National Provider Directory
Tax ID family
SPS LH Family Practice26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1609808716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3127",
            "address_2": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177010127"
        },
        {
            "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": "570-321-2820",
            "fax_number": "570-321-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "SANTANGELO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760176",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1603595",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUECROSS",
            "identifier": "50054352",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPS-Neurology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.