NPIMap

Organization Active NPI

Good Samaritan Physician Services

Doing business as WellSpan Family Medicine - West Cornwall

  • Family Medicine Physician
  • Lebanon, PA
National Provider Identifier
1821429994
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GOOD SAMARITAN PHYSICIAN SERVICES
Doing business as
WellSpan Family Medicine - West Cornwall
Practice address
101 Fairview Cir
Lebanon, PA 17042-9581
Phone
(717) 279-7303
Fax
(717) 279-7471
NPI assigned
Nov 27, 2013
Last updated
Oct 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Jody M Boger
Title
Credentialing Coordinator
Phone
(717) 270-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

101 Fairview Cir
Lebanon, PA 17042-9581

Mailing address

PO Box 300
Lebanon, PA 17042-0300
Phone (717) 270-7780

Other identifiers 1

IdentifierTypeStateIssuer
001864024MedicaidPA

Other names 1

  • WellSpan Family Medicine - West Cornwall Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000854 PA Part B Supplier - Clinic/Group Practice 5496728172 Receives reassigned benefits from 153 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ephrata, PA; York, PA; Waynesboro, PA; New Holland, PA; Lewisburg, PA; Lebanon, PA; Lancaster, PA; Chambersburg, PA…

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1821429994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170420300",
            "telephone_number": "717-270-7780",
            "fax_number": "717-274-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FAIRVIEW CIR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170429581",
            "telephone_number": "717-279-7303",
            "fax_number": "717-279-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "BOGER",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "717-270-7780"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001864024",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Family Medicine - West Cornwall",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.