NPIMap

Organization Active NPI

Wellspan Medical Group

  • Internal Medicine Physician
  • Dover, PA
National Provider Identifier
1619044880
Registry record updated Jan 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSPAN MEDICAL GROUP
Practice address
4020 Carlisle Rd
Dover, PA 17315-3508
Phone
(717) 851-6400
Fax
(717) 851-6410
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2018

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

Authorized official

Name
Ms. Christina Vest
Title
Credentialing Supervisor
Phone
(717) 851-1405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

4020 Carlisle Rd
Dover, PA 17315-3508

Mailing address

1803 Mount Rose Ave
Suite B3
York, PA 17403-3051
Phone (717) 851-6400

Other identifiers 12

IdentifierTypeStateIssuer
0301664001OtherPAAMERIHEALTH 65 PA
CA3246OtherPARAILROAD MEDICARE
KX54OtherMDCAREFIRST MD BCBS
1007721360106MedicaidPA
7368911OtherPAAETNA
86448OtherPAUNISON
02293900OtherPACAPITAL BLUE CROSS
S1EQOtherPAGEISINGER
1519815OtherPAGATEWAY
800174OtherPAJOHN HOPKINS
066330OtherPAHIGHMARK BLUE SHIELD
1142384OtherPAAMERIHEALTH MERCY

Other names 1

  • WELLSPAN INTERNAL MEDICINE - DOVER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000815 PA Part B Supplier - Clinic/Group Practice 1951213115 Receives reassigned benefits from 3,390 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0937590Wellspan Internal Med - Dover4020 Carlisle Road, Dover, PA 17315Certificate of waiverFeb 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Linda M Miller177 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4020 Carlisle Rd
York, PA 17315
Phone (717) 812-4240

308 Saint Charles Way
York, PA 17402
Phone (717) 430-5454

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515628800000",
    "number": "1619044880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 MOUNT ROSE AVE",
            "address_2": "SUITE B3",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033051",
            "telephone_number": "717-851-6400",
            "fax_number": "717-851-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 CARLISLE RD",
            "city": "DOVER",
            "state": "PA",
            "postal_code": "173153508",
            "telephone_number": "717-851-6400",
            "fax_number": "717-851-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2018-01-11",
        "status": "A",
        "authorized_official_last_name": "VEST",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "717-851-1405",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH 65 PA",
            "identifier": "0301664001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA3246",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "KX54",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007721360106",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7368911",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "86448",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02293900",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "S1EQ",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1519815",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN HOPKINS",
            "identifier": "800174",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "066330",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH MERCY",
            "identifier": "1142384",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WELLSPAN INTERNAL MEDICINE - DOVER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dover, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.