Susquehanna Community Health and Dental Clinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC.

Practice address

471 Hepburn St
Williamsport, PA 17701-6122

Phone

(570) 567-5400

Fax

(570) 567-5421

NPI assigned

Mar 12, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Ellen M Krajewski, NPH, CHES

Title

President/Chief Executive Officer

Phone

(570) 567-5412

Specialties & licenses 10

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• River Valley Health

  • Federally Qualified Health Center (FQHC)
  • Williamsport, PA
  • NPI 1184998361

  O20101026000280

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William P Bartlow, MD

  • Family Medicine Physician
  • Williamsport, PA
  • NPI 1881690501
  NPD (past)
• Michelle Marie Dangle, CRNP

  • Family Nurse Practitioner
  • Williamsport, PA
  • NPI 1053567990
  NPD (past)

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1831412246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 HEPBURN ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016122",
            "telephone_number": "570-567-5400",
            "fax_number": "570-567-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 HEPBURN ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016122",
            "telephone_number": "570-567-5400",
            "fax_number": "570-567-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-12",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "KRAJEWSKI",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "570-567-5412",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NPH, CHES"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "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": []
}

• Lynne R Stugart, RPH
• Joshua Stutzman, D.O.
• Michael Su, MD
• Lily Summers Trasiewicz, PA
• Susquehanna Cardiology Associates, P. C.
• Susquehanna Health Pharmacy
• Susquehanna Imaging Associates, Inc.
• Susquehanna Physician Services
• Susquehanna Physician Services (Susquehanna Health Medical Group)
• Susquehanna Physician Services (Susquehanna Health Medical Group)

• Family Medicine Physician in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.