Individual provider Active NPI

Cecelia Rae Martin, PAC

  • Physician Assistant
  • Lebanon, PA
National Provider Identifier
1942964663
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA062866 Issued in PA
Practice address
775 Norman Dr
Lebanon, PA 17042-7497
Phone
(717) 274-5500
NPI assigned
Oct 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA062866 PA Primary

Addresses

Primary practice location

775 Norman Dr
Lebanon, PA 17042-7497

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Other practice location 1

500 University Dr
Hershey, PA 17033-2360
Phone (800) 243-1455

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmartin15@direct.psu.edu

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211105000802 PA Practitioner - Physician Assistant 5395134738 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

25 Monument Rd
York, PA 17403-5073

2618 E Market St
Autumn House
York, PA 17403
Phone (717) 845-7214

775 Norman Dr
Lebanon, PA 17042-7497

914 W Market St
Autumn House West
York, PA 17403
Phone (717) 845-7214

Hospital & facility affiliations

  • Wellspan Good Samaritan Hospital Hospital, Lebanon, PA, CCN 390066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA062866PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Feb 8, 2023 Accepting new patients
The Milton S Hershey Medical Center Physicians Group CurrentSince Dec 7, 2021 Accepting new patients
Wellspan Medical Group CurrentSince Feb 8, 2023 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Dec 7, 2021 Accepting new patients

Locations

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

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

775 Norman Dr
Lebanon, PA 17042
Phone (717) 274-5500

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

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

1600 S George St
York, PA 17403
Phone (717) 848-3615

Interoperability endpoints

  • Direct secure messaging: cmartin350025@wellspan.direct-ci.com

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1942964663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 NORMAN DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427497",
            "telephone_number": "717-274-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 University Dr",
            "address_purpose": "LOCATION",
            "city": "Hershey",
            "state": "PA",
            "postal_code": "170332360",
            "country_code": "US",
            "telephone_number": "800-243-1455",
            "fax_number": "717-531-4587",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CECELIA",
        "middle_name": "RAE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-28",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmartin15@direct.psu.edu",
            "affiliation": "N",
            "address_1": "500 University Dr",
            "city": "Hershey",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170332360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.