NPIMap

Organization Active NPI

Evangelical Medical Services Organization

Doing business as WellSpan Behavioral Health

  • Clinical Psychologist
  • Lewisburg, PA
National Provider Identifier
1720187370
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS016860 Issued in PA
Legal business name
EVANGELICAL MEDICAL SERVICES ORGANIZATION
Doing business as
WellSpan Behavioral Health
Practice address
1 Hospital Dr
Lewisburg, PA 17837-9350
Phone
(570) 523-3324
Fax
(570) 523-7057
NPI assigned
Sep 21, 2006
Last updated
Sep 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Authorized official

Name
Kendra A Aucker
Title
Senior Vice President/President
Phone
(570) 522-2807

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PA
Clinical Psychologist 103TC0700X PS016860 PA Primary
Marriage & Family Therapist 106H00000X PA

Addresses

Primary practice location

1 Hospital Dr
Lewisburg, PA 17837-9350

Mailing address

1 Hospital Dr
Lewisburg, PA 17837-9350
Phone (570) 522-4110

Other names 1

  • WellSpan Behavioral Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000212 PA Part B Supplier - Clinic/Group Practice 9133033087 Receives reassigned benefits from 372 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewisburg, PA; Middleburg, PA; Mifflinburg, PA; Milton, PA; New Columbia, PA; Northumberland, PA; Selinsgrove, PA; Shamokin Dam, PA…

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1720187370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-522-4110",
            "fax_number": "570-768-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-523-3324",
            "fax_number": "570-523-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANGELICAL MEDICAL SERVICES ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "AUCKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT/PRESIDENT",
        "authorized_official_telephone_number": "570-522-2807"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS016860",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.