NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

Doing business as St. Luke's Stroudsburg Internal Medicine

  • Internal Medicine Physician
  • Stroudsburg, PA
National Provider Identifier
1629489562
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD065140L Issued in PA
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Doing business as
St. Luke's Stroudsburg Internal Medicine
Practice address
208 Lifeline Rd
Suite 203
Stroudsburg, PA 18360-6473
Phone
(484) 526-4999
NPI assigned
May 14, 2014
Last updated
May 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Authorized official

Name
Mr. Dean W Evans
Title
President
Phone
(484) 526-4991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD065140L PA Primary

Addresses

Primary practice location

208 Lifeline Rd
Suite 203
Stroudsburg, PA 18360-6473

Mailing address

208 Lifeline Rd
Suite 203
Stroudsburg, PA 18360-6473

Other names 1

  • St. Luke's Stroudsburg Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000062 PA Part B Supplier - Clinic/Group Practice 6709798333 Receives reassigned benefits from 3,523 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1629489562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LIFELINE RD",
            "address_2": "SUITE 203",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183606473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LIFELINE RD",
            "address_2": "SUITE 203",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183606473",
            "telephone_number": "484-526-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-526-4991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD065140L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Stroudsburg Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stroudsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; 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.