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WILLIAMSPORT REGIONAL MEDICAL CENTER SPU- DIVINE PROVIDENCE CAMPUS
NPI 1225500770
Clinic/Center - Ambulatory Surgical in Williamsport, PA

Active since December 21, 2018CLIA 39D0188862 · Accreditation
1100 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701(570) 326-8000 Get Directions Write a Review

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 15, 2020, Feb 27, 2020, Feb 5, 2020 and 1 more (4 updates tracked since 2018).

About Williamsport Regional Medical Center Spu- Divine Providence Campus NPPES

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

WILLIAMSPORT REGIONAL MEDICAL CENTER SPU- DIVINE PROVIDENCE CAMPUS (NPI 1225500770) is a healthcare organization registered as an ambulatory surgical in Williamsport, Pennsylvania and active in the NPI registry since December 2018. The organization holds an CLIA Accreditation certificate valid through January 2, 2027 and lists Christopher Stockhausen, Cfo, as its authorized official.

NPPES Registry Identity

NPI1225500770
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameUPMC WILLIAMSPORT
Location Address1100 GRAMPIAN BLVDWilliamsport, PA 17701-1909
Mailing Address600 Grant St, Us Steel Tower, 59th Floor, C/o Renee JohnsonPittsburgh, PA 15219-2740 · (412) 623-6303 · Fax (412) 623-6369
Phone(570) 326-8000
Organization SubpartNo
Authorized OfficialChristopher StockhausenCfo · (412) 578-9592
Enumeration DateDecember 21, 2018
Last NPPES UpdateNovember 27, 20234 updates tracked since enumeration
NPPES CertifiedSeptember 15, 2020
✔ NPI 1225500770 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1100 GRAMPIAN BLVD, Williamsport, PA 17701
Open in Google Maps ↗

Other Names 1

Doing Business AsWilliamsport Regional Medical Center Spu- Divine Providence Campus

Other Identifiers 1

Medicaid1007548350043PA

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Williamsport Regional Medical Center Spu- Divine Providence Campus is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StatePennsylvaniaEnrollment IDO20071211000513Part A · HospitalDue dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

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 Accreditation 39D0188862

Williamsport Region Med Center Divine Providence Campus · Williamsport, PA
Active · expires Jan 2, 2027
CLIA Number39D0188862
Laboratory TypeHospital
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorDr. Jamie L. Adam
Laboratory Phone(717) 326-8167
Laboratory LocationWilliamsport Region Med Center Divine Providence Campus1100 Grampian Blvd, Williamsport, PA 17701
CLIA data matches this NPI record on: Address
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 20

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

VERONICA MOON
Registered Nurse
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7690
MS. SARA JO RITCHEY PA-C
Physician Assistant
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7680
MRS. MINDI NICHOLS CRNP
Nurse Practitioner
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7691
HOME NURSING AGENCY & VISITING NURSE ASSOCIATION
Home Health
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7690
ROHIT G SINGH MD
Pain Medicine (Pain Medicine)
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 326-8457
DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Registered Nurse
1100 GRAMPIAN BLVD, 4 SOUTH
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7690
ASHLEY LEBERFINGER M.D.
Plastic Surgery
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 326-8005
KARL AHLSWEDE MD
Surgery (Hospice and Palliative Medicine)
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA 17701
Lycoming County (570) 320-7680

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 Upmc Williamsport's NPI number?

The NPI number for Upmc Williamsport is 1225500770. It was assigned to this organization in the NPPES registry on December 21, 2018. The provider is doing business as Williamsport Regional Medical Center Spu- Divine Providence Campus.

Where is Upmc Williamsport located?

Upmc Williamsport is located at 1100 Grampian Blvd, Williamsport, PA 17701. The listed phone number is (570) 326-8000.

What is Upmc Williamsport's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Upmc Williamsport enrolled in Medicare?

Yes. Upmc Williamsport is registered in the Medicare PECOS enrollment system.

When is Upmc Williamsport's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Pennsylvania, Hospital) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Upmc Williamsport hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 39D0188862) is associated with this NPI, valid through January 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Upmc Williamsport was last updated on November 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.