SUSQUEHANNA PHYSICIAN SERVICES (NPI# 1326078536) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326078536 |
| Entity Type | Organization |
| Organization Name | SUSQUEHANNA PHYSICIAN SERVICES |
| Other Organization Name | SUSQUEHANNA HEALTH MEDICAL GROUP |
| Practice Address |
1100 Grampian Blvd Williamsport PA 17701-1909 |
| Mailing Address |
1201 Grampian Blvd Williamsport PA 17701-1900 |
| Practice Telephone | 5703268200 |
| Practice Fax Number | 5703207540 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-10-21 |
| Authorized Official Name | MS. MELISSA DAVIS (VP/COO) |
| Authorized Official Telephone | 5703207696 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | HIGHMARK BLUE SHIELD | 1429584 | 01 |
| PA | 0017300760197 | 05 |
| Other Name | Type Code |
|---|---|
| Susquehanna Health Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033345533 | Susquehanna Physician Services | Nurse Practitioner | 10 Shady Lane, Suite 201, Muncy, PA 17756-8807 | 2009-06-10 |
| 1477793172 | Susquehanna Physician Services | Physician Assistant | 1201 Grampian Blvd Ste 1a, Williamsport, PA 17701-1965 | 2009-02-20 |
| 1780603837 | Susquehanna Physician Services | Obstetrics & Gynecology | 2134 W 4th St, Williamsport, PA 17701-4344 | 2006-07-19 |
| 1083677868 | Susquehanna Physician Services | Internal Medicine | 700 High Street, Williamsport, PA 17701-3198 | 2006-04-11 |
| 1467453878 | Susquehanna Physician Services | Clinic/Center | 1112 Grampian Blvd, Williamsport, PA 17701-1909 | 2005-08-09 |
| 1578164943 | Susquehanna Physician Services | Podiatrist | 2370 Old Turnpike Rd Ste 4, Lewisburg, PA 17837-6567 | 2020-11-03 |
| 1982205472 | Susquehanna Physician Services | Clinic/Center | 416 S Main St Ste 1, Mansfield, PA 16933-1510 | 2020-11-03 |
| 1962018135 | Susquehanna Physician Services | Family Medicine | 700 High St Fl 9, Williamsport, PA 17701-3100 | 2020-09-22 |
| 1992359798 | Susquehanna Physician Services | Emergency Medicine | 700 High St, Williamsport, PA 17701-3100 | 2019-07-30 |
| 1689905606 | Susquehanna Physician Services | Nurse Practitioner | 777 Rural Ave, Williamsport, PA 17701-3109 | 2010-01-15 |
| Street Address |
1100 GRAMPIAN BLVD |
| City | WILLIAMSPORT |
| State | PA |
| Zip Code | 17701-1909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902804339 | Jennifer Ellyn Bayer | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2005-07-11 |
| 1225647548 | Justin Silverstrim | Physician Assistant | 1100 Grampian Blvd, Williamsport, PA 17701-1907 | 2020-07-23 |
| 1346862745 | Kyle Creighton Thiel | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1907 | 2020-05-08 |
| 1598399610 | Jacquelyn Elaine Baker | Social Worker | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2020-02-27 |
| 1811531304 | Elizabeth Belz | Physician Assistant | 1100 Grampian Blvd, Williamsport, PA 17701-1907 | 2019-10-29 |
| 1881157618 | Stephanie Herman | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2019-04-09 |
| 1376017947 | Amanda Marie Swanson | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2019-01-17 |
| 1225500770 | Upmc Williamsport | Clinic/Center | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2018-12-21 |
| 1649746488 | Upmc Williamsport | Psychiatric Unit | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2018-10-19 |
| 1164907226 | Robin Elaine Sammons | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2018-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184267809 | Charlene Angella Pitter | Nurse Practitioner | 170 Warren Ave, Williamsport, PA 17701 | 2019-10-25 |
| 1396395299 | Susan E Fetzer | Occupational Therapy Assistant | Upmc Susquehanna,625 West Edwin Street, Williamsport, PA 17701 | 2019-09-13 |
| 1184280984 | Craig Andrew Tuller | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency, 740 High Street, Suite 4001, Williamsport, PA 17701 | 2019-05-16 |
| 1760048045 | Michael Harvey | Student in an Organized Health Care Education/Training Program | 740 High St. Suite 4001, Williamsport, PA 17701 | 2019-05-13 |
| 1275196008 | Olivia Fladmark | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency 740 High St, Suite 4001, Williamsport, PA 17701 | 2019-04-17 |
| 1528551231 | Mark Hampton Chiropractic Inc. | Durable Medical Equipment & Medical Supplies | 1111 East 3rd Street, Williamsport, PA 17701 | 2018-06-08 |
| 1548710882 | Central Pennsylvania Rehabilitation Medicine, Inc | Physical Medicine & Rehabilitation | 460 River Ave Ste 1, Williamsport, PA 17701 | 2016-10-11 |
| 1376096784 | Christine Kessler | Physician Assistant | One College Ave, Penna. College of Tech, Pa Program Dif 123, Williamsport, PA 17701 | 2016-08-02 |
| 1629440276 | Matthew Ray Rebuck | Specialist/Technologist | 220 N Reach Rd, Williamsport, PA 17701 | 2015-10-22 |
| 1508237223 | Neihl Williamson | Physician Assistant | 1205 Grampian Blvd Ste 3c, Williamsport, PA 17701 | 2015-10-08 |
| Find all providers in zip 17701 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831243690 | Timothy Judge | Surgery | 740 High St Ste 1003, Williamsport, PA 17701-3102 | 2007-01-22 |
| 1356318497 | Scott Douglas Croll | Surgery | 740 High Street, Suite 1003, Williamsport, PA 17701-3100 | 2006-03-08 |
| 1588183867 | Mohammad Tahir | Surgery | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2017-09-18 |
| 1316177876 | Jasneet Singh Bhullar | Surgery | 740 High St, Suite 1003, Williamsport, PA 17701-3100 | 2009-07-19 |
| 1396862900 | Okwudili Francis Chukwuani | Surgery | 777 Rural Ave, Williamsport, PA 17701-3145 | 2007-03-26 |
| 1962469650 | Michael J Lazar | Surgery | 740 High St, Suite 2001, Williamsport, PA 17701-3102 | 2006-04-27 |
| 1568423341 | Timothy James Pagana | Surgery | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2006-03-31 |
| 1528036266 | Susan Ann Branton | Surgery | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2006-03-09 |
| 1689642340 | Rodrick Albert Stevenson | Surgery | 699 Rural Ave, Suite 104, Williamsport, PA 17701-3246 | 2006-03-09 |
| 1326010125 | John L. Holup | Surgery | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2006-02-06 |
| Find all providers in WILLIAMSPORT | ||||
| City | WILLIAMSPORT |
| Zip Code | 17701 |
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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.