WELLSPAN TRAUMA & CRITICAL CARE SURGERY (WELLSPAN MEDICAL GROUP) NPI 1316333487

Surgery (Trauma Surgery) in York, PA

NPI 1316333487 Organization Surgery Trauma Surgery CLIA Number 39D2129074 CLIA Certificate of Waiver

About WELLSPAN TRAUMA & CRITICAL CARE SURGERY (WELLSPAN MEDICAL GROUP)

Wellspan Trauma & Critical Care Surgery (wellspan Medical Group) is a provider established in York, Pennsylvania specializing in surgery (trauma surgery) . The NPI number of Wellspan Trauma & Critical Care Surgery (wellspan Medical Group) is 1316333487 and was assigned on April 2015. The practitioner's primary taxonomy code is 2086S0127X. The provider is registered as an organization and their NPI record was last updated 4 years ago. Wellspan Trauma & Critical Care Surgery (wellspan Medical Group) operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Wellspan Trauma & Critical Care Surgery. The authorized official of this NPI record is Ms. Christina Moon (Credentialing Supervisor)

The CLIA number of Wellspan Trauma & Critical Care Surgery is 39D2129074 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Wellspan Trauma & Critical Care Surgery to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1316333487

Provider NameWELLSPAN TRAUMA & CRITICAL CARE SURGERY (WELLSPAN MEDICAL GROUP)
Provider Location Address300 PINE GROVE CMNS YORK, PA 17403
Provider Mailing Address3421 CONCORD RD YORK, PA 17402
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameWELLSPAN TRAUMA & CRITICAL CARE SURGERY
Other Name TypeDoing Business As (3)
Enumeration Date04-15-2015
Last Update Date09-19-2017


Primary Taxonomy

Taxonomy Code2086S0127X
ClassificationSurgery
TypeAllopathic & Osteopathic Physicians
SpecializationTrauma Surgery
Taxonomy DescriptionTrauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency.

Business Address

WELLSPAN TRAUMA & CRITICAL CARE SURGERY
300 PINE GROVE CMNS
YORK, PA
ZIP 17403
Phone: (717) 851-6110
Fax: (717) 741-1076

Get Directions


Mailing Address

WELLSPAN TRAUMA & CRITICAL CARE SURGERY
3421 CONCORD RD
YORK, PA
ZIP 17402
Phone:
Fax: (717) 848-2074



Authorized Official

Authorized Official NameMS. CHRISTINA MOON
Authorized Official TitleCREDENTIALING SUPERVISOR
Authorized Official Phone(717) 851-1405

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1316333487 is:

CLIA Number39D2129074
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


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

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
12086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareNo

Taxonomy Description: a surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.

2363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalNo

Taxonomy Description: Not Available

3363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthNo

Taxonomy Description: Not Available

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
117038FLTMEDICARE PIN (08)PA

Other Providers at the same location


The following 18 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1649722802WELLSPAN MEDICAL GROUP
Organization
Surgery (Pediatric Surgery)300 PINE GROVE CMNS
YORK, PA 17403
(717) 812-2479
1730149535DR. SHAWN MICHAEL TERRY M.D.
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1063479970 DANIEL E CARNEY MD
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1346281607DR. MICHAEL P NAJARIAN MD
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1851320493DR. EBONDO MPINGA MD
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1093917221 JESSE GODDARD M.D.
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1235398355DR. GRAHAM G LAURENCE M.D.
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1265743959 SHABNAM HAFIZ MD
Individual
Surgery (Surgical Critical Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1992962997DR. ALI KHALID JAWED M.D.
Individual
Surgery300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1942768981 GEORGE D SCHEURICH CRNP
Individual
Nurse Practitioner (Acute Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1790210532 COURTNEY N LACZKO PA-C
Individual
Physician Assistant300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1629627401 CARLY JO BOLTON PA
Individual
Physician Assistant300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1740549427 AMY JILL BRICKNER CRNP
Individual
Nurse Practitioner (Pediatrics)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1386021624 HEIDI MICHELLE RICKER CRNP
Individual
Nurse Practitioner (Acute Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1285277913 SARA ANNE LISCHERELLI
Individual
Nurse Practitioner (Critical Care Medicine)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1023651668 ANDREA BACHMAN CRNP
Individual
Nurse Practitioner (Acute Care)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1003005174MR. DAVID M. GILMAN PA-C
Individual
Physician Assistant300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110
1144894981 REBECCA LYNN HOMAN CRNP
Individual
Nurse Practitioner (Family)300 PINE GROVE CMNS
YORK, PA 17403
(717) 851-6110

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.