Individual provider Active NPI

Timothy J Labosh, M.D.

  • Family Medicine Physician
  • East Petersburg, PA
National Provider Identifier
1629064530
Registry record updated Nov 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD042074E Issued in PA
Practice address
5665 Main St
East Petersburg, PA 17520-1513
Phone
(717) 569-7011
Fax
(717) 569-8694
NPI assigned
Sep 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD042074E PA Primary

Addresses

Primary practice location

5665 Main St
East Petersburg, PA 17520-1513

Mailing address

5665 Main St
East Petersburg, PA 17520-1513
Phone (717) 569-7011

Other identifiers 8

IdentifierTypeStateIssuer
40026 S1QCOtherPAGEISINGER HEALTH PLAN
604065OtherPAHIGHMARK BLUE SHIELD
0015297170003MedicaidPA
01957301OtherPACAPITAL BLUE CROSS
515152OtherPAAETNA HMO
5818042OtherPAAETNA NON-HMO
P002630OtherPAGATEWAY HEALTH PLAN
E53671OtherPAHEALTH ASSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100308000075 PA Practitioner - Family Practice 6901941574 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD042074EPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Aug 1, 1995 Accepting new patients
Lancaster General Medical Group Family Medicine CurrentSince Aug 1, 1995 Accepting new patients
Lancaster General Medical Group Current Accepting new patients

Locations

5665 Main St
East Petersburg, PA 17520
Phone (717) 569-7011

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

1001 Cornerstone Dr
#B
Mount Joy, PA 17552
Phone (717) 653-2929

Interoperability endpoints

  • Direct secure messaging: tlabosh2929@direct-lghealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258329600000",
    "number": "1629064530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 MAIN ST",
            "city": "EAST PETERSBURG",
            "state": "PA",
            "postal_code": "175201513",
            "telephone_number": "717-569-7011",
            "fax_number": "717-569-8694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 MAIN ST",
            "city": "EAST PETERSBURG",
            "state": "PA",
            "postal_code": "175201513",
            "telephone_number": "717-569-7011",
            "fax_number": "717-569-8694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABOSH",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2009-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD042074E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "40026 S1QC",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "604065",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015297170003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "01957301",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "515152",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5818042",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY HEALTH PLAN",
            "identifier": "P002630",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "E53671",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Petersburg, PA

Sources for this page

Verify at the official NPI Registry.