NPIMap

Individual provider Active NPI

Mandy R Fannin, M.D.

  • Family Medicine Physician
  • Ephrata, PA
National Provider Identifier
1972725877
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD436272 Issued in PA
Practice address
136 Lake St
Ephrata, PA 17522-2415
Phone
(717) 721-7718
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT188133 PA
Family Medicine Physician 207Q00000X MD436272 PA Primary

Addresses

Primary practice location

136 Lake St
Ephrata, PA 17522-2415

Mailing address

561 W Trout Run Rd
Ephrata, PA 17522-9604
Phone (717) 733-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090811000340 PA Practitioner - Family Practice 1456405414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

136 Lake St
Ephrata, PA 17522-2415
Phone (717) 721-7718

25 Monument Rd
York, PA 17403-5073

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

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

Hospital & facility affiliations

  • Wellspan Ephrata Community Hospital Hospital, Ephrata, PA, CCN 390225
  • Wellspan York Hospital Hospital, York, PA, CCN 390046
  • Lancaster General Hospital Hospital, Lancaster, PA, CCN 390100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD436272PAMDFamily Medicine Physician
MT188133PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Current Accepting new patients
Wellspan Medical Group Family Medicine CurrentSince May 5, 2017 Accepting new patients
Wellspan Medical Group CurrentSince May 5, 2017 Accepting new patients
Wellspan Medical Group Family Medicine Past Accepting new patients
Ephrata Community Hospital Past Accepting new patients

Locations

561 W Trout Run Rd
Ephrata, PA 17522
Phone (717) 220-3494

808 Pleasantview Dr
Ephrata, PA 17522
Phone (717) 733-6518

175 Martin Ave
Ste 125
Ephrata, PA 17522
Phone (717) 812-4602

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

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

Interoperability endpoints

  • Direct secure messaging: mfannin@direct-address.net
  • Direct secure messaging: mfannin38930@wellspan.direct-ci.com

Organizations & group practices 5

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 11

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1972725877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 W TROUT RUN RD",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175229604",
            "telephone_number": "717-733-9090",
            "fax_number": "717-733-8982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 LAKE ST",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175222415",
            "telephone_number": "717-721-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNIN",
        "first_name": "MANDY",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT188133",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD436272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ephrata, PA

Sources for this page

Verify at the official NPI Registry.