NPIMap

Organization Active NPI

The Good Samaritan Hospital of Lebanon, Pennsylvania

  • Emergency Medicine Physician
  • Lebanon, PA
National Provider Identifier
1730754284
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Practice address
252 S 4TH St
Lebanon, PA 17042-6123
Phone
(717) 851-3057
NPI assigned
May 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Tina Citro
Title
VP & President
Phone
(717) 738-6407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

252 S 4TH St
Lebanon, PA 17042-6123

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other identifiers 1

IdentifierTypeStateIssuer
1007732780070MedicaidPA

Other names 2

  • WellSpan Good Samaritan Hospital Doing business as
  • WellSpan Good Samaritan Hospital Emergency Department Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040420001427 PA Part B Supplier - Clinic/Group Practice 5597751206 Receives reassigned benefits from 44 practitioners
1 other NPI on this enrollment
Practice locations: Lebanon, PA
O20080108000258 PA Part A Provider - Hospital 5597751206 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palmyra, PA; Myerstown, PA; Lebanon, PA

Hospital certification: CCN 390066

Legal name
THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Doing business as
WELLSPAN GOOD SAMARITAN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 2, 2023
Beds
163 (145 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 23, 1891 in PA
Enrollment address
252 S 4TH St
Lebanon, PA 17042-6123
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wellspan Good Samaritan HospitalCCN 390066
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

618 Cornwall Rd
Lebanon, PA 17042
Phone (717) 273-4646

750 Norman Dr
Lebanon, PA 17042
Phone (717) 270-7551

206 Hathaway Park
Lebanon, PA 17042
Phone (717) 270-2349

830 Tuck St
Lebanon, PA 17042
Phone (717) 228-1620

781 Norman Dr
Lebanon, PA 17042
Phone (717) 270-1252

297 W Lincoln Ave
Myerstown, PA 17067
Phone (717) 866-9452

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Buczkowski Individual Corporate OfficerSenior VP and Cfo Nov 30, 2020
W-2 Managing EmployeeSenior VP and Cfo Nov 30, 2020
Roxanna L Gapstur Individual OtherPresident, Wellspan Health Jan 2, 2019
Robert Hoffman Individual Corporate Officer Jul 30, 2020
Corporate Director Nov 1, 2016
Robert J Funk Individual Corporate Director Nov 1, 2016
Stephen a Lindsey Individual Corporate Director Jan 1, 2021
Christopher L Grant Individual Corporate Director Jan 1, 2021
Tina M Citro Individual Corporate OfficerVP and President WS GSH Mar 23, 2025
Corporate DirectorVP and President WS GSH Mar 23, 2025
W-2 Managing EmployeeVP and President WS GSH Mar 23, 2025
Roger Zimmerman Individual Corporate Director Jan 1, 2021
Carrie Wilson Individual Corporate OfficerVice Chair Jan 1, 2021
Moniqua Acosta Individual Corporate OfficerChair Jan 1, 2021
Corporate Director Jan 1, 2021
Michael B Seim Individual Corporate DirectorEx-Officio Jan 1, 2021
Kimberly Shaun Kreider Umble Individual Corporate Director Jan 1, 2021
Wellspan Health Organization, York, PA Non-profit Operational/Managerial Control Jul 1, 2015
Other Jul 1, 2015
Edward Joseph Tadajweski Individual Corporate Director Jan 1, 2021
James Stuccio Individual Corporate OfficerEx-Officio (Voting) Jan 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 52

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

View all 52

Affiliated clinicians 679

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 679

NPI Registry JSON

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1730754284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "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": "252 S 4TH ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426123",
            "telephone_number": "717-851-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "CITRO",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "VP & PRESIDENT",
        "authorized_official_telephone_number": "717-738-6407"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007732780070",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WellSpan Good Samaritan Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellSpan Good Samaritan Hospital Emergency Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.