Individual provider Active NPI

Andrea Levine, D.O,

  • Family Medicine Physician
  • Lebanon, PA
National Provider Identifier
1881072296
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OT016399 Issued in PA
Practice address
30 N 4TH St
4TH and Willow Streets
Lebanon, PA 17046-5606
Phone
(717) 274-0474
NPI assigned
May 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OT016399 PA Primary

Addresses

Primary practice location

30 N 4TH St
4TH and Willow Streets
Lebanon, PA 17046-5606

Mailing address

30 N 4TH St
4TH and Willow Streets
Lebanon, PA 17046-5606
Phone (717) 274-0474

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20190306002802 CA Practitioner - Family Practice 9537408661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Arizona College of Osteopathic Medicine Mid Western University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

365 E Hillcrest Dr
Thousand Oaks, CA 91360-5820
Phone (805) 374-7433

3900 Alamo St
Simi Valley, CA 93063-2111
Phone (805) 582-0100

5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone (818) 719-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT016399PAMDFamily Medicine Physician
16529CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 18, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 18, 2018 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 3

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": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1881072296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 4TH ST",
            "address_2": "4TH AND WILLOW STREETS",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170465606",
            "telephone_number": "717-274-0474"
        },
        {
            "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": "170465606",
            "telephone_number": "717-274-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "ANDREA",
        "credential": "D.O,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT016399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.