Wellspan Medical Group
Organization Active NPI Family Medicine Physician · New Freedom, PA
NPI 1629146709 · NPPES record last updated Oct 27, 2021
Key facts
- NPI
- 1629146709
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- WELLSPAN MEDICAL GROUP
- Practice address
- 13515 Wolfe Rd
Suite C
New Freedom, PA 17349-9346 - Phone
- (717) 812-2501
- Fax
- (717) 461-7178
- NPI assigned
- Nov 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Laura Frank
- Title
- Manager-CVS
- Phone
- (717) 851-1405
Corporate family (same tax ID) 24
Practitioners 17
-
Rina Jane Baughman, CRNP
-
Nadege Toubou Fackche, M.D.
-
Heather Gersbacher Hazlett, RPA C
-
Maria A. Kasper, D.P.M.
-
Amy Reed, CRNA
-
Stephen Michael Scrimenti, PH.D.
-
Frank Joseph Stanko, M.S.
-
Tracey Elizabeth Wiley, CRNP
-
Madad Ali, M.D.
-
Breanne Leigh Ceranske, PA-C
-
Donald S. Diefendorf, P.A.-C
-
Karen Kubota Slabas, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Linda M Miller
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
13515 Wolfe Rd
Suite C
New Freedom, PA 17349-9346
Mailing address
3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0756543002 | Other | PA | AMERIHEALTH 65 PA |
| 596398 | Other | PA | HIGHMARK BLUE SHIELD |
| 800174 | Other | PA | JOHN HOPKINS |
| 02298200 | Other | PA | CAPITAL BLUE CROSS |
| 1007721360114 | Medicaid | PA | |
| 1519303 | Other | PA | GATEWAY |
| 5551045 | Other | PA | AETNA |
| 82204 | Other | PA | UNISON |
| 1142414 | Other | PA | AMERIHEALTH MERCY |
| CA3246 | Other | PA | RAILROAD MEDICARE |
| KX10 | Other | MD | CAREFIRST MD BCBS |
| S1E1 | Other | PA | GEISINGER |
Other names
- WELLSPAN FAMILY MEDICINE - STONEBRIDGE
Other providers in New Freedom, PA
- Madison Jayne Tomasic
- Razvan Theodor Vaida
- Holly R Wade
- Karlye Lynne Webster
- Wellspan Health Newberry LLC
- Elizabeth Williams
- Jenny Zhu
- Gary B Zimberg
All providers in New Freedom, PA · Family Medicine 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 Oct 27, 2021. 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.