NPIMap

Organization Active NPI

St. Luke's Physician Group, Inc.

Doing business as Willam Penn Family Practice Center

  • Family Medicine Physician
  • Bethlehem, PA
National Provider Identifier
1790814895
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. LUKE'S PHYSICIAN GROUP, INC.
Doing business as
Willam Penn Family Practice Center
Practice address
4379 Easton Ave
Bethlehem, PA 18020-1483
Phone
(610) 814-2424
NPI assigned
Mar 5, 2007
Last updated
Apr 19, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 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) 954-6048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PA Primary

Addresses

Primary practice location

4379 Easton Ave
Bethlehem, PA 18020-1483

Mailing address

623 E Broad St
2ND FLR
Bethlehem, PA 18018-6332
Phone (610) 954-6048

Other names 1

  • WILLAM PENN FAMILY PRACTICE CENTER 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
St Lukes Surgical Assoc165 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

4379 Easton Ave
Ste 100
Bethlehem, PA 18020
Phone (484) 503-2424

543 Interchange Rd
Kresgeville, PA 18333
Phone (272) 212-5230

Practitioners & affiliated clinicians

Practitioners 7

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271635200000",
    "number": "1790814895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 E BROAD ST",
            "address_2": "2ND FLR",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180186332",
            "telephone_number": "610-954-6048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4379 EASTON AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180201483",
            "telephone_number": "610-814-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2010-04-19",
        "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": "610-954-6048"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLAM PENN FAMILY PRACTICE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.