NPIMap

Organization Active NPI

Wellspan Medical Group

Doing business as WellSpan Family Medicine-Roosevelt Avenue

  • Family Medicine Physician
  • York, PA
National Provider Identifier
1881020808
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSPAN MEDICAL GROUP
Doing business as
WellSpan Family Medicine-Roosevelt Avenue
Practice address
1401 Roosevelt Ave
York, PA 17404-2244
Phone
(717) 812-7000
Fax
(717) 767-8985
NPI assigned
Sep 23, 2013
Last updated
Jan 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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 Supervisor
Phone
(717) 851-1405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1401 Roosevelt Ave
York, PA 17404-2244

Mailing address

1803 Mount Rose Ave Ste B3
York, PA 17403-3051
Phone (717) 812-7000

Other names 1

  • WellSpan Family Medicine-Roosevelt Avenue 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

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": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1881020808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 MOUNT ROSE AVE STE B3",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174033051",
            "telephone_number": "717-812-7000",
            "fax_number": "717-767-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 ROOSEVELT AVE",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174042244",
            "telephone_number": "717-812-7000",
            "fax_number": "717-767-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-23",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "717-851-1405",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpan Family Medicine-Roosevelt Avenue",
            "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 Jan 10, 2014; 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.