Lancaster General Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LANCASTER GENERAL MEDICAL GROUP

Doing business as

Penn Medicine LGHP Family Medicine County Line

Practice address

5360 Lincoln Highway East, Store #15
Village at Gap
Gap, PA 17527-9461

Phone

(717) 442-8111

Fax

(717) 442-8981

NPI assigned

Jul 1, 2006

Last updated

Nov 17, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

LANCASTER GENERAL MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Denise Kennedy

Title

Vice President Financial Services

Phone

(717) 544-5010

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Penn Medicine LGHP Family Medicine County Line Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Lancaster Rheumatology

Practitioners 7

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.

• Luke Bingaman, PA-C

  • Medical Physician Assistant
  • Lancaster, PA
  • NPI 1912308206
  NPD
• Kimberly Brooke Rivera Bourke, PA-C

  • Physician Assistant
  • Elizabethtown, PA
  • NPI 1992129142
  NPD
• Kirby Lee Graham, PA-C

  • Medical Physician Assistant
  • Gap, PA
  • NPI 1861164907
  NPD
• Mona M Jhaveri, M.D.

  • Internal Medicine Physician
  • Marietta, PA
  • NPI 1053397489
  NPD
• David C Lang, PA-C

  • Physician Assistant
  • Lancaster, PA
  • NPI 1376073742
  NPD
• Beth Lynley McCampbell, MD

  • Plastic Surgery Physician
  • York, PA
  • NPI 1174688337
  NPD
• Stephanie Erin Wile, CRNP

  • Family Nurse Practitioner
  • Ephrata, PA
  • NPI 1316369135
  NPD

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1922037126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 LINCOLN HIGHWAY EAST, STORE #15",
            "address_2": "VILLAGE AT GAP",
            "city": "GAP",
            "state": "PA",
            "postal_code": "175279461",
            "telephone_number": "717-442-8111",
            "fax_number": "717-442-8981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 LINCOLN HIGHWAY EAST, STORE #15",
            "address_2": "VILLAGE AT GAP",
            "city": "GAP",
            "state": "PA",
            "postal_code": "175279461",
            "telephone_number": "717-442-8111",
            "fax_number": "717-442-8981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANCASTER GENERAL MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANCASTER GENERAL MEDICAL GROUP",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "717-544-5010"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007327490138",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Penn Medicine LGHP Family Medicine County Line",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen L Keegan, PT, MDT
• Gina Louise Kielbasa, LPN
• Randy L Kochel, MD
• Carla Kouterick
• Lakisha Kumedzro, CEO
• Allison Lapp, DC
• Robert N Mackey, P.T.
• Jennifer Ann Markward
• John A McCarthy, LAC
• Lisa Marie McLain, COTA/L

• Family Medicine Physician in Gap, PA
• Providers in Gap, 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 Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.