NPIMap

Organization Active NPI

Susquehanna Physician Services

  • Family Medicine Physician
  • Lock Haven, PA
National Provider Identifier
1972548337
Registry record updated Oct 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Practice address
610 High St
Lock Haven, PA 17745-3031
Phone
(570) 748-1260
Fax
(570) 748-1261
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2015

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

Authorized official

Name
Ms. Melissa Davis
Title
VP/Coo
Phone
(570) 320-7696

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

610 High St
Lock Haven, PA 17745-3031

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Other identifiers 2

IdentifierTypeStateIssuer
0017300760152MedicaidPA
804540OtherPAHIGHMARK BLUE SHIELD

Other names 1

  • Susquehanna Health Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426001371 PA Part B Supplier - Clinic/Group Practice 2264336460 Receives reassigned benefits from 21 practitioners
Practice locations: Lock Haven, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445212800000",
    "number": "1972548337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 HIGH ST",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177453031",
            "telephone_number": "570-748-1260",
            "fax_number": "570-748-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2015-10-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "570-320-7696",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760152",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "804540",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lock Haven, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; 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.