NPIMap

Organization Active NPI

Wellspan Medical Group

  • Podiatrist
  • Fayetteville, PA
National Provider Identifier
1700567260
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
WELLSPAN MEDICAL GROUP
Practice address
8131 Spyglass Hill Dr
Fayetteville, PA 17222-5500
Phone
(717) 264-5211
Fax
(717) 264-5418
NPI assigned
Jul 27, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Authorized official

Name
Laura Frank
Title
Credentialing Manager
Phone
(717) 851-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

8131 Spyglass Hill Dr
Fayetteville, PA 17222-5500

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Other names 1

  • WellSpan Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

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
O20250502002365 PA DME Supplier - Physician - Podiatry 1951213115 Practice locations: Fayetteville, PA

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
39D2315506Wellspan Podiatry - Penn National8131 Spyglass Hill Drive, Fayetteville, PA 17222Certificate of waiverDec 12, 2026

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellspan Internal MedicineLititz, PA, CCN 395631 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 29, 2015
Apr 8, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2,441

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

View all 2,441

NPI Registry JSON

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1700567260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8131 SPYGLASS HILL DR",
            "city": "FAYETTEVILLE",
            "state": "PA",
            "postal_code": "172225500",
            "telephone_number": "717-264-5211",
            "fax_number": "717-264-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "717-851-6832"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, PA

Sources for this page

Verify at the official NPI Registry.