NPIMap

Organization Active NPI

Susquehanna Physician Services

Doing business as Susquehanna Health Medical Group

  • Rheumatology Physician
  • Williamsport, PA
National Provider Identifier
1801830807
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Doing business as
Susquehanna Health Medical Group
Practice address
1705 Warren Ave
Suite 101-103
Williamsport, PA 17701-2647
Phone
(570) 321-2020
Fax
(570) 320-7501
NPI assigned
Jun 16, 2006
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Mrs. Melissa Davis
Title
VP/Coo
Phone
(570) 320-7696

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X
Pediatric Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2088P0231X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1705 Warren Ave
Suite 101-103
Williamsport, PA 17701-2647

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Other names 1

  • Susquehanna Health Medical Group Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040526000532 PA Part B Supplier - Clinic/Group Practice 2264336460 Receives reassigned benefits from 22 practitioners
Practice locations: Lock Haven, PA; Williamsport, PA; Mansfield, PA; Lewisburg, PA
O20230605001491 PA DME Supplier - Physician - Urology 2264336460 Practice locations: Williamsport, PA

National Provider Directory

National Provider Directory

Locations

24 Cree Dr
Fl 3
Lock Haven, PA 17745
Phone (570) 893-5120

740 High St
Ste 2001
Williamsport, PA 17701
Phone (570) 321-2805

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1801830807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 WARREN AVE",
            "address_2": "SUITE 101-103",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012647",
            "telephone_number": "570-321-2020",
            "fax_number": "570-320-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "570-320-7696",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Susquehanna Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.