Provider Demographics
| NPI: | 1740249325 |
|---|---|
| Name: | WELLSPAN MEDICAL GROUP |
| Entity type: | Organization |
| Organization Name: | WELLSPAN MEDICAL GROUP |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR PATIENT FINANCIAL SERVICES |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JENNIFER |
| Authorized Official - Middle Name: | ELAINE |
| Authorized Official - Last Name: | SWEITZER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 717-851-6838 |
| Mailing Address - Street 1: | 601 MEMORY LN |
| Mailing Address - Street 2: | |
| Mailing Address - City: | YORK |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 17402-2231 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 717-851-1405 |
| Mailing Address - Fax: | 717-851-6969 |
| Practice Address - Street 1: | 1407 WILLIAMS RD |
| Practice Address - Street 2: | |
| Practice Address - City: | YORK |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 17402-9012 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 717-851-6340 |
| Practice Address - Fax: | 717-851-6349 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-03-21 |
| Last Update Date: | 2025-02-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101Y00000X, 101YA0400X, 103G00000X, 103T00000X, 1041C0700X, 2084A0401X, 2084N0400X, 2084N0402X, 2084P0005X, 2084P0800X, 2084P0802X, 2084P0804X, 2084P0805X, 363L00000X | ||
| PA | 104100000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
| No | 2084P0005X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | Group - Multi-Specialty |
| No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 100772136 0360 | Medicaid | |
| PA | 2081595 | Other | CIGNA BEHAVIORAL HEALTH |
| PA | 2091237 | Other | BLUE SHIELD |
| PA | 100772136 | Medicaid | |
| PA | 2081597 | Other | CIGNA BEHAVIORAL HEALTH |
| PA | 2148186 | Other | CIGNA BEHAVIORAL HEALTH |
| PA | 2081591 | Other | CIGNA BEHAVIORAL HEALTH |
| PA | 2164697 | Other | CIGNA BEHAVIORAL HEALTH |
| PA | 7162248 | Other | AETNA |
| 02303700 | Other | CAPITAL BLUE CROSS | |
| PA | 925715 | Other | BLUE SHIELD |
| PA | 925716 | Other | BUE SHIELD |
| PA | 1681714 | Other | BLUE SHIELD |
| PA | 306906 | Other | MANAGED HEALTH NETWORK |
| PA | 100772136 | Medicaid |
