NPIMap

Organization Active NPI

Wellspan Medical Group

Doing business as St. Charles Internal Medicine

  • Internal Medicine Physician
  • York, PA
National Provider Identifier
1801954276
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSPAN MEDICAL GROUP
Doing business as
St. Charles Internal Medicine
Practice address
296 St. Charles Way
York, PA 17402-4648
Phone
(717) 851-6567
Fax
(717) 851-6577
NPI assigned
Dec 5, 2006
Last updated
Aug 11, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Ms. Amy F Wilkinson
Title
Credentialing Coordinator
Phone
(717) 851-1405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

296 St. Charles Way
York, PA 17402-4648

Mailing address

1803 Mount Rose Ave
Suite B3
York, PA 17403-3051
Phone (717) 851-1405

Other identifiers 12

IdentifierTypeStateIssuer
CA3246OtherPARAILROAD MEDICARE
KX54OtherMDCAREFIRST MD BCBS
369120OtherPAHIGHMARK BLUE SHIELD
S1EZOtherPAGEISINGER
0021280001OtherPAAMERIHEALTH 65 PA
84533OtherPAUNISON
5894771OtherPAAETNA
02293500OtherPACAPITAL BLUE CROSS
1007721360132MedicaidPA
1519314OtherPAGATEWAY
800174OtherPAJOHN HOPKINS
1142430OtherPAAMERIHEALTH MERCY

Other names 1

  • St. Charles Internal Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000815 PA Part B Supplier - Clinic/Group Practice 1951213115 Receives reassigned benefits from 3,390 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
York Health Systems Med177 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

4222 Lincoln Hwy
York, PA 17406
Phone (717) 812-2050

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": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1801954276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 MOUNT ROSE AVE",
            "address_2": "SUITE B3",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033051",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 ST. CHARLES WAY",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174024648",
            "telephone_number": "717-851-6567",
            "fax_number": "717-851-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-851-1405",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA3246",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "KX54",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "369120",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "S1EZ",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH 65 PA",
            "identifier": "0021280001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "84533",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5894771",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02293500",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007721360132",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1519314",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN HOPKINS",
            "identifier": "800174",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH MERCY",
            "identifier": "1142430",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Charles Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in York, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.