NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

Doing business as St. Luke's Internal Medicine Bangor

  • Internal Medicine Physician
  • Bangor, PA
National Provider Identifier
1730403304
Registry record updated Mar 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Doing business as
St. Luke's Internal Medicine Bangor
Practice address
125 S 1St St
Bangor, PA 18013-2615
Phone
(610) 588-8282
Fax
(610) 588-5761
NPI assigned
Mar 25, 2010
Last updated
Mar 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2010

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

Authorized official

Name
Dean W. Evans
Title
President
Phone
(610) 954-3383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

125 S 1St St
Bangor, PA 18013-2615

Mailing address

125 S 1St St
Bangor, PA 18013-2615
Phone (610) 588-8282

Other names 1

  • St. Luke's Internal Medicine Bangor 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
Tax ID family
Orthopaedic Surgical GR165 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

Locations

555 Delaware Ave
Ste 1
Palmerton, PA 18071
Phone (610) 826-4420

Practitioners & affiliated clinicians

Practitioners 5

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": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1730403304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S 1ST ST",
            "city": "BANGOR",
            "state": "PA",
            "postal_code": "180132615",
            "telephone_number": "610-588-8282",
            "fax_number": "610-588-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S 1ST ST",
            "city": "BANGOR",
            "state": "PA",
            "postal_code": "180132615",
            "telephone_number": "610-588-8282",
            "fax_number": "610-588-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2010-03-25",
        "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": "610-954-3383"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Internal Medicine Bangor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.