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WELLSPAN FAMILY MEDICINE - NORTH FOURTH STREET
NPI 1316076961
Family Medicine in Lebanon, PA

Active since March 02, 2007CLIA 39D0185947 · Microscopy
30 N 4TH ST, 2ND FLOOR, LEBANON, PA 17046(717) 274-0474(717) 274-0673 Get Directions Write a Review

NPPES record last updated: October 4, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wellspan Family Medicine - North Fourth Street NPPES

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

WELLSPAN FAMILY MEDICINE - NORTH FOURTH STREET (NPI 1316076961) is a healthcare organization registered as a family medicine in Lebanon, Pennsylvania and active in the NPI registry since March 2007. The organization holds a CLIA Microscopy certificate valid through June 29, 2028 and lists Jody M Boger, Credentialing Coordinator, as its authorized official.

NPPES Registry Identity

NPI1316076961
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameGOOD SAMARITAN PHYSICIAN SERVICES
Location Address30 N 4TH ST, 2ND FLOORLebanon, PA 17046-5606
Mailing AddressPo Box 300Lebanon, PA 17042-0300 · (717) 270-7780 · Fax (717) 274-9746
Phone(717) 274-0474
Fax(717) 274-0673
Organization SubpartNo
Authorized OfficialJody M BogerCredentialing Coordinator · (717) 270-7780
Enumeration DateMarch 2, 2007
Last NPPES UpdateOctober 4, 2016
✔ NPI 1316076961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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.
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedPediatricsTaxonomy 208000000X
30 N 4TH ST, Lebanon, PA 17046
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Other Names 1

Doing Business AsWellspan Family Medicine - North Fourth Street

Other Identifiers 2

Medicare PIN047659PA
Medicaid001864024PA

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 for Provider-Performed Microscopy Procedures (PPMP) 39D0185947

Wellspan Fam Med North 4th St · Lebanon, PA
Active · expires Jun 29, 2028
CLIA Number39D0185947
Laboratory TypePhysician Office
Certificate Effective DateJune 30, 2026
Certificate Expiration DateJune 29, 2028
Laboratory DirectorDr. Sukhjeet K. Kamboj
Laboratory Phone(717) 274-0474
Laboratory LocationWellspan Fam Med North 4th St30 N 4th Street, 2nd Flr, Lebanon, PA 17046
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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.

MANSEY VARGHESE MD
Family Medicine
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 274-0474
ANTHONY LAL
Family Medicine
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 274-0474
ANILA GIDWANI DPT
Physical Therapist
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 270-7500
SABA SARFRAZ
Family Medicine
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 274-0474
ILHAM AHMED UMAR
Family Medicine
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 274-0474
DR. TRAJAN BARRERA DO
Family Medicine
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 270-1949
MATIN MOHAMMAD MD
Physical Medicine & Rehabilitation
30 N 4TH ST
LEBANON, PA 17046
Lebanon County (717) 270-7500
SAMANTHA M FITZPATRICK SW
Social Worker
30 N 4TH ST, 2ND FLOOR
LEBANON, PA 17046
Lebanon County (717) 274-0474

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 Good Samaritan Physician Services's NPI number?

The NPI number for Good Samaritan Physician Services is 1316076961. It was assigned to this organization in the NPPES registry on March 2, 2007. The provider is doing business as Wellspan Family Medicine - North Fourth Street.

Where is Good Samaritan Physician Services located?

Good Samaritan Physician Services is located at 30 N 4th St 2nd Floor, Lebanon, PA 17046. The listed phone number is (717) 274-0474.

What is Good Samaritan Physician Services's specialty?

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

Does Good Samaritan Physician Services hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 39D0185947) is associated with this NPI, valid through June 29, 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 Good Samaritan Physician Services was last updated on October 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.