NPIMap

Organization Active NPI

Lebanon Internal Medicine Associates, P.C.

  • Internal Medicine Physician
  • Lebanon, PA
National Provider Identifier
1700878261
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LEBANON INTERNAL MEDICINE ASSOCIATES, P.C.
Practice address
755 Norman Dr
Lebanon, PA 17042-7497
Phone
(717) 273-6706
Fax
(717) 273-1435
NPI assigned
Aug 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Authorized official

Name
Dr. Thomas V Kantor, M.D.NPI 1962494401
Title
Group President
Phone
(717) 273-6706

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

755 Norman Dr
Lebanon, PA 17042-7497

Mailing address

755 Norman Dr
Lebanon, PA 17042-7497
Phone (717) 273-6706

Other identifiers 5

IdentifierTypeStateIssuer
1520937OtherPAGATEWAY - SPECIALIST
104037OtherPAHIGHMARK BLUE SHIELD
02377100OtherPACAPITAL BLUE CROSS
1007532100010MedicaidPA
1511102OtherPAGATEWAY - PRIMARY CARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040607000723 PA Part B Supplier - Clinic/Group Practice 1951383553 Receives reassigned benefits from 30 practitioners
1 other NPI on this enrollment
Practice locations: Lebanon, PA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

550 E Main St
Annville, PA 17003
Phone (717) 867-4467

755 Norman Dr
Lebanon, PA 17042
Phone (717) 273-6706

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1700878261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-273-6706",
            "fax_number": "717-273-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-273-6706",
            "fax_number": "717-273-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON INTERNAL MEDICINE ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "KANTOR",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "GROUP PRESIDENT",
        "authorized_official_telephone_number": "717-273-6706",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY - SPECIALIST",
            "identifier": "1520937",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "104037",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02377100",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007532100010",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY - PRIMARY CARE",
            "identifier": "1511102",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.