WELLSPAN MEDICAL GROUP (NPI# 1104988740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104988740 |
| Entity Type | Organization |
| Organization Name | WELLSPAN MEDICAL GROUP |
| Other Organization Name | WELLSPAN CARDIOTHORACIC SURGERY |
| Practice Address |
25 Monument Road Suite 190 York PA 17403-5059 |
| Mailing Address |
1803 Mount Rose Ave Suite B3 York PA 17403-3051 |
| Practice Telephone | 7178516454 |
| Practice Fax Number | 7178511665 |
| Mailing Telephone | 7178511405 |
| Mailing Fax Number | 7178511665 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2017-05-10 |
| Authorized Official Name | MS. AMY F WILKINSON (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 7178511405 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1007721360105 | 05 | |
| PA | JOHN HOPKINS | 800174 | 01 |
| PA | 1007721360246 | 05 | |
| MD | 401065514 | 05 | |
| PA | CAPITAL BLUE CROSS | 50039030 | 01 |
| PA | HIGHMARK BLUE SHIELD | 1628553 | 01 |
| PA | AMERIHEALTH MERCY | 20034217 | 01 |
| PA | AMERIHEALTH 65PA | 2305610000 | 01 |
| PA | GEISINGER | 344T | 01 |
| PA | RAILROAD MEDICARE | CA3246 | 01 |
| PA | GATEWAY | 1536225 | 01 |
| PA | AETNA | 7619892 | 01 |
| MD | CAREFIRST MD BCBS-STE 190 | 04P5 | 01 |
| MD | CAREFIRST BCBS | KC94 | 01 |
| Other Name | Type Code |
|---|---|
| Wellspan Cardiothoracic Surgery | 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 |
25 MONUMENT ROAD SUITE 190 |
| City | YORK |
| State | PA |
| Zip Code | 17403-5059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285631754 | Richard Bryant Damewood | Surgery | 25 Monument Road, Suite #120, York, PA 17403-5049 | 2005-06-30 |
| 1447279583 | David Foster Baskwill | Podiatrist | 25 Monument Road, Apple Hill Podiatry Assoc Suite 130, York, PA 17403 | 2006-07-19 |
| 1285672030 | Samuel J Solomon | Internal Medicine | 25 Monument Road, Suite 200, York, PA 17403 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113286 | Maria Frances Defelice | Social Worker | 1902 Woodland Rd, York, PA 17403 | 2020-01-11 |
| 1710524335 | White Deer Run LLC | Community/Behavioral Health | 257 E Market Street, 2nd Floor, York, PA 17403 | 2019-12-02 |
| 1275016917 | Laura Anne Wanenchak | Speech-Language Pathologist | Genesis Rehab Services, 2760 Pine Grove Road, York, PA 17403 | 2018-09-10 |
| 1306355771 | Emily Good | Occupational Therapist | 34 N Albemarle St, York, PA 17403 | 2017-09-28 |
| 1275054983 | Lindsay Sentz | Nurse Anesthetist, Certified Registered | 110 Pine Grove Commons, York, PA 17403 | 2017-07-03 |
| 1649721713 | Omasiel Herenia Comrie-reinert | Nurse Practitioner | 2690 Southfield Dr Ste A, York, PA 17403 | 2016-10-24 |
| 1144675703 | Audrey C Hess | Dietitian, Registered | 35 Monument Rd Suite 202, Wellspan Maternal Fetal Medicine, York, PA 17403 | 2016-05-02 |
| 1346616505 | Joseph A Tolomeo | Psychologist | 807 S. George St, York, PA 17403 | 2015-08-11 |
| 1750798328 | Charles W. Hash Jr. | Surgery | 1400 E. Market St., York, PA 17403 | 2014-07-16 |
| 1124430764 | Kelly Michael Martin | Registered Nurse | 1001 S. Gearge St, York, PA 17403 | 2014-06-02 |
| Find all providers in zip 17403 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174730238 | Appledore Mediacal Grp II, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12 Hospital Dr Ste A, York, ME 03909-1030 | 2007-05-17 |
| 1124233044 | Appledore Medical Grp II, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 16 Hospital Dr Ste 101, York, ME 03909-1041 | 2007-05-14 |
| 1689627259 | Cardiac and Thoracic Surgery Associates | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 410 Shady Dell Rd, York, PA 17403-4483 | 2006-05-18 |
| 1629071360 | Bradley Howard Levin | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1750 Starcross Rd, York, PA 17403-4540 | 2005-05-26 |
| 1114113040 | Appledore Medical Group II Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12 Hospital Dr, Suite 9, York, ME 03909-1030 | 2007-09-25 |
| 1477752699 | Appledore Medical Group II Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12 Hospital Dr, Suite A, York, ME 03909-1030 | 2007-07-17 |
| 1326128968 | David L Robaczewski | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 25 Monument Rd, York, PA 17403-5060 | 2006-10-17 |
| 1801833868 | Mark W Burlingame | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 25 Monument Rd, Suite 190, York, PA 17403-5060 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639707847 | West Virginia Univesity Medical Corporation | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1163 Country Club Rd Ste 106, Monongahela, PA 15063-1013 | 2020-04-01 |
| 1861959884 | Pedro Augusto Reck Dos Santos | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 200 Lothrop St # C900, Pittsburgh, PA 15213-2536 | 2019-02-26 |
| 1023582418 | Luciana Da Fonseca Da Silva | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4401 Penn Ave Fl 5, Pittsburgh, PA 15224-1334 | 2019-01-18 |
| 1962980730 | Wellspan Medical Group | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 40 V Twin Dr Ste 102, Gettysburg, PA 17325-7878 | 2018-08-02 |
| 1295110427 | Chananya Karunasumetta | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4101 Penn Avenue, 5th Fl. Faculty Pavilion, Pittsburgh, PA 15224 | 2015-07-29 |
| 1528443041 | Michael Ibrahim | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3701 Chestnut St Apt 410, Philadelphia, PA 19104-3104 | 2015-07-27 |
| 1710386420 | Ferdinand Christian | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1224 Turnbury Ln, North Wales, PA 19454-3657 | 2014-08-19 |
| 1245668128 | Jacob Kolff | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1125 Bryn Llawn Road, Villanova, PA 19085 | 2013-10-31 |
| 1144665399 | William Schuler Pierce | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1201 Saradana Road, Harrisburg, PA 17112 | 2013-05-01 |
| 1215279112 | Jeffrey M Dunn | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 200 W. Washington Sq, #1207, Philadelphia, PA 19106 | 2013-03-19 |
| Find all providers with the same taxonomy | ||||
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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.