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WELLSPAN FAMILY MEDICINE - FREDERICK ST
NPI 1114292760
Family Medicine in Hanover, PA

Active since March 15, 2012CLIA 39D1048135 · Waiver
100 FREDERICK ST, SUITE 101, HANOVER, PA 17331(717) 851-7050(717) 632-7478 Get Directions Write a Review

NPPES record last updated: January 11, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 11, 2018, Dec 22, 2015 (2 updates tracked since 2015).

About Wellspan Family Medicine - Frederick St NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLSPAN FAMILY MEDICINE - FREDERICK ST (NPI 1114292760) is a healthcare organization registered as a family medicine in Hanover, Pennsylvania and active in the NPI registry since March 2012. The organization holds a CLIA Waiver certificate valid through June 20, 2028 and lists Christina Vest, Credentialing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1114292760
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameWELLSPAN MEDICAL GROUP
Location Address100 FREDERICK ST, SUITE 101Hanover, PA 17331-3518
Mailing Address1803 Mount Rose Ave, Suite B3York, PA 17403-3026 · (717) 851-6816 · Fax (717) 632-7478
Phone(717) 851-7050
Fax(717) 632-7478
Organization SubpartNo
Authorized OfficialChristina VestCredentialing Supervisor · (717) 851-1405
Enumeration DateMarch 15, 2012
Last NPPES UpdateJanuary 11, 20182 updates tracked since enumeration
✔ NPI 1114292760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
100 FREDERICK ST, Hanover, PA 17331
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Other Names 1

Doing Business AsWellspan Family Medicine - Frederick St

Other Identifiers 5

Other2695421PA · Highmark Blue Shield
Other30112625PA · Amerihealth Mercy - Wmg
Other1603334PA · Gateway Health Plan
Other50107968PA · Capital Blue Cross - Wmg
Other9886818PA · Aetna

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D1048135

Wellspan Family Medicine Frederick St · Hanover, PA
Active · expires Jun 20, 2028
CLIA Number39D1048135
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2026
Certificate Expiration DateJune 20, 2028
Laboratory DirectorDr. G Panisri Rao
Laboratory Phone(717) 632-7474
Laboratory LocationWellspan Family Medicine Frederick St100 Frederick Street, Suite 101, Hanover, PA 17331
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FAMILY MEDICINE OF HANOVER LLC
Family Medicine
100 FREDERICK ST
HANOVER, PA 17331
York County (717) 632-7474
HEIDI MILES
Nurse Practitioner (Family)
100 FREDERICK ST, STE 101
HANOVER, PA 17331
York County (717) 851-7050
DR. VERNON H PRESTON M.D.
Family Medicine
100 FREDERICK ST, SUITE 101
HANOVER, PA 17331
York County (717) 851-7050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wellspan Medical Group's NPI number?

The NPI number for Wellspan Medical Group is 1114292760. It was assigned to this organization in the NPPES registry on March 15, 2012. The provider is doing business as Wellspan Family Medicine - Frederick St.

Where is Wellspan Medical Group located?

Wellspan Medical Group is located at 100 Frederick St Suite 101, Hanover, PA 17331. The listed phone number is (717) 851-7050.

What is Wellspan Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Wellspan Medical Group hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D1048135) is associated with this NPI, valid through June 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wellspan Medical Group was last updated on January 11, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.