NPIMap

Organization Active NPI

Premise Health of Pennsylvania Medical, P.C

  • Multi-Specialty Clinic/Center
  • Hanover Township, PA
National Provider Identifier
1689457715
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C
Practice address
550 New Commerce Blvd
Hanover Township, PA 18706-1404
Phone
(615) 468-3188
NPI assigned
Aug 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Authorized official

Name
Jon Leizman, MD
Title
President
Phone
(615) 468-6270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

550 New Commerce Blvd
Hanover Township, PA 18706-1404

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Adidas Wilkes-Barre Health Center Doing business as

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
39D2292144Premise Health of Pennsylvania Medical, PC550 New Commerce Blvd, Wilkes Barre, PA 18706Certificate of waiverOct 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Pennsylvania Medical PC17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

550 New Commerce Blvd
Hanover Township, PA 18706

NPI Registry JSON

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1689457715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NEW COMMERCE BLVD",
            "city": "HANOVER TOWNSHIP",
            "state": "PA",
            "postal_code": "187061404",
            "telephone_number": "615-468-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF PENNSYLVANIA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-468-6270",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adidas Wilkes-Barre Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hanover Township, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.