Individual provider Active NPI

Walter E Pae Jr., MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Hershey, PA
National Provider Identifier
1841258522
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
MD021710E Issued in PA
Practice address
500 University Dr
Hershey, PA 17033-2360
Phone
(800) 233-4082
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD021710E PA Primary
Surgery Physician 208600000X MD021710E PA

Addresses

Primary practice location

500 University Dr
Hershey, PA 17033-2360

Mailing address

PO Box 854
MC A410
Hershey, PA 17033-0854
Phone (800) 233-4082

Other practice location 1

25 Monument Rd Ste 190
York, PA 17403-5059
Phone (717) 851-6454

Other identifiers 1

IdentifierTypeStateIssuer
0008075510001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120209000315 PA Practitioner - Thoracic Surgery 9335306901 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD021710EPAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Current Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Aug 7, 1981 Accepting new patients
The Milton S Hershey Medical Center - Physicians Group Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Aug 7, 1981 Accepting new patients
Wellspan Medical Group CurrentSince Nov 21, 2017 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Wellspan Medical Group CurrentSince Nov 21, 2017 Accepting new patients

Locations

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

25 Monument Rd
Ste 190
York, PA 17403
Phone (717) 741-8011

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841258522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 854",
            "address_2": "MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170330854",
            "telephone_number": "800-233-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "800-233-4082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Monument Rd Ste 190",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174035059",
            "country_code": "US",
            "telephone_number": "717-851-6454",
            "fax_number": "717-851-1665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAE",
        "first_name": "WALTER",
        "middle_name": "E",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD021710E",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD021710E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008075510001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hershey, PA

Sources for this page

Verify at the official NPI Registry.