WELLSPAN MEDICAL GROUP (NPI# 1205308954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205308954 |
| Entity Type | Organization |
| Organization Name | WELLSPAN MEDICAL GROUP |
| Practice Address |
912 Russell Dr Lebanon PA 17042-7485 |
| Practice Telephone | 7172702336 |
| Practice Fax Number | 7176392741 |
| Mailing Telephone | 7172702336 |
| Mailing Fax Number | 7176392741 |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2018-12-19 |
| Authorized Official Name | JULIANN DIAZ (CREDENTIALING SUPERVISOR) |
| Authorized Official Telephone | 7178517134 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellSpan Occupational Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962980730 | Wellspan Medical Group | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 40 V Twin Dr Ste 102, Gettysburg, PA 17325-7878 | 2018-08-02 |
| 1245490515 | Wellspan Medical Group | Surgery | 50 Wyntre Brooke Dr, York, PA 17403-4535 | 2008-06-11 |
| 1184784704 | Wellspan Medical Group | Internal Medicine | 40 V Twin Dr Ste 204, Gettysburg, PA 17325-7878 | 2006-12-12 |
| 1801954276 | Wellspan Medical Group | Internal Medicine | 296 St. Charles Way, York, PA 17402-4648 | 2006-12-05 |
| 1649348525 | Wellspan Medical Group | Physician Assistant | 105 4th St # 727, East Berlin, PA 17316-9638 | 2006-12-01 |
| 1790853695 | Wellspan Medical Group | Family Medicine | 4910a Fairfield Road, Fairfield, PA 17320-9510 | 2006-12-01 |
| 1801982426 | Wellspan Medical Group | Pain Medicine | 140 Pine Grove Commons, York, PA 17403-5151 | 2006-10-04 |
| 1194819193 | Wellspan Medical Group | Neurological Surgery | 228 Saint Charles Way, York, PA 17402-4644 | 2006-10-03 |
| 1740236900 | Wellspan Medical Group | Orthopaedic Surgery | 18 Deatrick Drive, Gettysburg, PA 17325-6958 | 2006-05-26 |
| 1215994934 | Wellspan Medical Group | Family Medicine | 924 Colonial Ave Ste B, York, PA 17403-3450 | 2006-04-27 |
| Street Address |
912 RUSSELL DR |
| City | LEBANON |
| State | PA |
| Zip Code | 17042-7485 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225013642 | Robert Campbell | Anesthesiology | 912 Russell Dr, Lebanon, PA 17042-7485 | 2005-12-08 |
| 1932573482 | Erika J Peavy | Physician Assistant | 912 Russell Dr, Lebanon, PA 17042-7485 | 2015-11-20 |
| 1477927408 | Amy Jo Krall | Nurse Practitioner | 912 Russell Dr, Lebanon, PA 17042-7485 | 2015-11-13 |
| 1861759342 | Ian M Yarger | Podiatrist | 912 Russell Dr, Lebanon, PA 17042-7485 | 2012-04-20 |
| 1821354176 | Sirish Kumar Kondabolu | Orthopaedic Surgery | 912 Russell Dr, Lebanon, PA 17042 | 2012-04-11 |
| 1851687362 | Jitesh Umarvadia | Family Medicine | 912 Russell Dr, Lebanon, PA 17042-7485 | 2011-06-22 |
| 1932417128 | Anthony Guy Helwig | Orthopaedic Surgery | 912 Russell Dr, Lebanon, PA 17042-7485 | 2010-09-22 |
| 1770777427 | Wendy Lynn Updegrove | Physician Assistant | 912 Russell Dr, Lebanon, PA 17042-7485 | 2007-09-05 |
| 1881892172 | David Trigg Streets | Orthopaedic Surgery | 912 Russell Dr, Lebanon, PA 17042-7485 | 2007-07-07 |
| 1417972902 | Scott M. Williams | Orthopaedic Surgery | 912 Russell Dr, Lebanon, PA 17042 | 2006-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023676384 | Sandra L Pistone | Registered Nurse | 905 S. 2nd Ave, Lebanon, PA 17042 | 2019-06-03 |
| 1154848414 | Kihc, LLC | Home Health | 900-c Centerville Road, Suite C, Lancaster, PA 17042 | 2017-08-28 |
| 1316301724 | Good Samaritan Physician Services | Radiology | 844 Tuck Street, Lebanon, PA 17042 | 2016-04-12 |
| 1609265883 | Ashley Hess | Behavioral Analyst | 15th South 9th Street, Lebanon, PA 17042 | 2015-01-12 |
| 1932504727 | Anthony Salvadore Petrole | Physician Assistant | 252 4th Street, Lebanon, PA 17042 | 2014-10-23 |
| 1801209713 | Matthew Johnson | Family Medicine | 920 Church Street, Lebanon, PA 17042 | 2014-06-09 |
| 1437414505 | Odalys Gonzalez-rodriguez | Physical Therapist | 1700 S Lincoln Ave., Lebanon Vmac Bldg 102 Room 120, Lebanon, PA 17042 | 2012-07-05 |
| 1750677175 | Anita Lyn Stokes | Speech-Language Pathologist | 1126 Walnut Street, Lebanon, PA 17042 | 2011-06-23 |
| 1205126497 | Karey Lynn Foote | Pharmacist | 415 S. 9th St, Lebanon, PA 17042 | 2011-04-09 |
| 1013227685 | T. W. Ponessa and Associates Counseling Services, Inc. | Community/Behavioral Health | 101 E. Evergreen Road, Lebanon, PA 17042 | 2010-10-18 |
| Find all providers in zip 17042 | ||||
| Taxonomy Code | 2083X0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Occupational Medicine |
| Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063616464 | Raymond H Hicks | Preventive Medicine | 1 Medical Ctr, Lebanon, NH 03756-0001 | 2007-06-12 |
| 1699960989 | Bethesda Healthcare Inc | Preventive Medicine | 100 Arrow Springs Blvd, Lebanon, OH 45036-9864 | 2007-09-10 |
| 1144363532 | Karen L Huyck | Preventive Medicine | 1 Medical Center Dr, Dhmc, Department of Occupational Medicine, Lebanon, NH 03756-1000 | 2007-02-15 |
| 1134266885 | Madelynn Azar-cavanagh | Preventive Medicine | One Medical Center Drive, Dartmouth Hitchcock - Occupational Medicine, Lebanon, NH 03756 | 2007-01-31 |
| 1821179029 | James L. Jordan | Preventive Medicine | 331 Hospital Dr, Suite D, Lebanon, MO 65536-9217 | 2006-10-17 |
| 1699783373 | Robert Keene Mclellan | Preventive Medicine | 1 Medical Center Dr, Lebanon, NH 03756-1000 | 2006-08-04 |
| 1518946771 | Phillip B Collins | Preventive Medicine | 127 Mascoma St, Lebanon, NH 03766-2661 | 2006-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609311257 | St. Luke's Hospital Monroe Campus | Preventive Medicine | 200 St. Luke's Lane, Stroudsburg, PA 18360 | 2017-01-05 |
| 1700288826 | Allegheny Clinic | Preventive Medicine | 4 Allegheny Center, 10th Floor, Pittsburgh, PA 15212-4756 | 2014-09-19 |
| 1073851895 | John Dexter Forbes | Preventive Medicine | 310 Chaucer Ct N, Sewickley, PA 15143-8728 | 2013-01-29 |
| 1447598735 | Lloyd B Tepper | Preventive Medicine | 1420 Old Gulph Rd, Villanova, PA 19085-1921 | 2013-01-22 |
| 1417213125 | Michael Samuel Riviello | Preventive Medicine | 1 Tullamore Dr, West Chester, PA 19382-7065 | 2012-04-06 |
| 1669748984 | Robert Allan Barlow Jr. | Preventive Medicine | 1296 University Dr, Yardley, PA 19067-2826 | 2012-03-30 |
| 1760774756 | Jack Morton Stein | Preventive Medicine | 1735 Market St, 14th Floor, Philadelphia, PA 19103-7501 | 2011-05-09 |
| 1548575103 | Stephen Louis Klincewicz | Preventive Medicine | 1006 Stonebridge Rd, Ambler, PA 19002-2034 | 2010-08-07 |
| 1275853012 | Mohannad Kusti | Preventive Medicine | 600 Grant St Ste 1650, Pittsburgh, PA 15219-2755 | 2010-06-03 |
| 1801112834 | Pete Kwabena Obeng | Preventive Medicine | 292 Frantz Rd, Ste 102, Stroudsburg, PA 18360 | 2010-04-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.