NPIMap

Organization Active NPI

Lancaster General Hospital

Doing business as Penn Medicine LGHP Geriatrics

  • Geriatric Medicine (Family Medicine) Physician
  • Willow Street, PA
National Provider Identifier
1619023124
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
LANCASTER GENERAL HOSPITAL
Doing business as
Penn Medicine LGHP Geriatrics
Practice address
212 Willow Valley Lakes Dr
Willow Street, PA 17584-9668
Phone
(717) 464-9173
Fax
(717) 464-0823
NPI assigned
Jan 26, 2007
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LANCASTER GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Gary A Welch
Title
Chief Operating Officer
Phone
(717) 544-5658

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X PA Primary

Addresses

Primary practice location

212 Willow Valley Lakes Dr
Willow Street, PA 17584-9668

Mailing address

212 Willow Valley Lakes Dr
Willow Street, PA 17584-9668
Phone (717) 464-9173

Other identifiers 5

IdentifierTypeStateIssuer
001399238OtherPAHIGHMARK BLUE SHIELD
2087959000OtherPAAMERIHEALTH 65
S1P6OtherPAGEISINGER
20054139OtherPAAMERIHEALTH MERCY
000000136758OtherPAUNISON

Other names 1

  • Penn Medicine LGHP Geriatrics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000606 PA Part B Supplier - Clinic/Group Practice 1254240039 Receives reassigned benefits from 232 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quarryville, PA; Lancaster, PA; Lititz, PA; Parkesburg, PA; Willow Street, PA; Elizabethtown, PA; Ephrata, PA; Cornwall, PA…

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Lancaster Gen Hosp Lab45 organizations share this tax ID, including this one
Part of
Lancaster Gen Hosp Lab

Other organizations with this tax ID 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1619023124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 WILLOW VALLEY LAKES DR",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849668",
            "telephone_number": "717-464-9173",
            "fax_number": "717-464-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 WILLOW VALLEY LAKES DR",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849668",
            "telephone_number": "717-464-9173",
            "fax_number": "717-464-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANCASTER GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANCASTER GENERAL HOSPITAL",
        "enumeration_date": "2007-01-26",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "717-544-5658"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "001399238",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH 65",
            "identifier": "2087959000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "S1P6",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH MERCY",
            "identifier": "20054139",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000136758",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Penn Medicine LGHP Geriatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willow Street, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.