NPIMap

Organization Active NPI

Good Samaritan Physician Services

  • Social Worker
  • Lebanon, PA
National Provider Identifier
1861752073
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
GOOD SAMARITAN PHYSICIAN SERVICES
Practice address
30 N 4TH St
4TH and Willow Streets
Lebanon, PA 17046-4808
Phone
(717) 274-0474
Fax
(717) 274-0673
NPI assigned
May 22, 2012
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

30 N 4TH St
4TH and Willow Streets
Lebanon, PA 17046-4808

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
001864024MedicaidPA

Other names 1

  • Good Samaritan Physician Services Family Support Other name

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Physician Services10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1861752073",
    "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": "717-272-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 4TH ST",
            "address_2": "4TH AND WILLOW STREETS",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170464808",
            "telephone_number": "717-274-0474",
            "fax_number": "717-274-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2014-11-25",
        "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": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001864024",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Physician Services Family Support",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.