NPIMap

Individual provider Active NPI

Mary Ellen Wilson, M.D.

  • Family Medicine Physician
  • Camp Hill, PA
National Provider Identifier
1760825731
Registry record updated Oct 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD458058 Issued in PA
Practice address
3025 Market St
Suite B
Camp Hill, PA 17011-4518
Phone
(717) 691-1212
Fax
(717) 691-5354
NPI assigned
Apr 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X MD458058 PA Primary

Addresses

Primary practice location

3025 Market St
Suite B
Camp Hill, PA 17011-4518

Mailing address

PO Box 858
MC A410
Hershey, PA 17033-0858
Phone (800) 243-1455

Other names 1

  • Mary Ellen Lisman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161130000634 PA Practitioner - Family Practice 2769626100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2626 N 3Rd St
Harrisburg, PA 17110-2044
Phone (717) 232-5443

3025 Market St
Camp Hill, PA 17011-4518

500 Universidy Dr
Hershey, PA 17033-2360

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
56.69
Promoting interoperability
100
Improvement activities
40
Cost
74.52

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Family Medicine CurrentSince Sep 27, 2016 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Sep 27, 2016 Accepting new patients
The Milton S. Hershey Medical Center Physicians Group Family Medicine Past Accepting new patients

Locations

3025 Market St
Ste B
Camp Hill, PA 17011
Phone (717) 691-1212

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1760825731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 858",
            "address_2": "MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170330858",
            "telephone_number": "800-243-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 MARKET ST",
            "address_2": "SUITE B",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170114518",
            "telephone_number": "717-691-1212",
            "fax_number": "717-691-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARY ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-09",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD458058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY ELLEN",
            "last_name": "LISMAN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Camp Hill, PA

Sources for this page

Verify at the official NPI Registry.